Senior Population Health Analyst

Walt Disney; Seattle (WA); Hybrid; USD 90,000 - 120,000; Full time

Benefits offered by this job

PTO & holidays

401(k) match

Health insurance

Tuition reimbursement

Job summary

MVP Health Care is seeking a Health Analytics Specialist to advance Medicare, Commercial Exchange, and Medicaid/HARP analytics and reporting. The role focuses on risk adjustment initiatives, data-driven targeting, and translating complex data into actionable insights.

Proficiency in SQL and data visualization tools (Tableau, Power BI) and strong communication are essential to improve program targeting and ROI. Some travel is required to support organizational goals.

Qualifications

• Minimum Education: Bachelor’s Degree in Health Administration, Business, Economics, Health Informatics, or related field.
• Minimum Experience: 2 years in a business environment involving analysis of financial or other large data sets.

Responsibilities

• Perform analytics and reporting on Medicare, Commercial Exchange, and Medicaid/HARP member populations.
• Serve as analytical lead on prospective and retrospective population health management objectives, focusing on Risk Adjustment efforts.
• Lead co-workers on design targeting based upon disparate data sources to identify members with likely risk gaps.
• Provide regular reporting of Risk Adjustment programs and identify opportunities and obstacles.
• Measure capture rate of Hierarchical Condition Categories (HCCs) and diagnosis codes related to Risk Adjustment programs to improve and optimize program targeting for Medicare and commercial exchange populations.
• Use Clinical Risk Group (CRG) software to target interventions for improved coding for Medicaid members.
• Calculate ROI for Risk Adjustment programs.
• Maintain regulatory requirements for CMS and NYS related to supplemental data.
• Minimal travel required.
• Perform other duties as assigned.

Skills

Lead analytics

Project management

SQL

Data visualization

Communication

Attention to detail

Time management

Independent work

Data analysis

Tableau

Power BI

R

Python

Education

Bachelor’s Degree in Health Administration, Business, Economics, Health Informatics, or related field

Tools

Tableau

Power BI

Excel

R

Python

Job description

Overview

MVP Health Care is a nationally recognized, not-for-profit health insurer caring for members in NewYork and Vermont. Committed to the complete well‑being of our members and the communities we serve, MVP makes health insurance more convenient, supportive and personal.

Responsibilities

• Perform analytics and reporting on Medicare, Commercial Exchange, and Medicaid/HARP member populations.
• Serve as analytical lead on prospective and retrospective population health management objectives, focusing on Risk Adjustment efforts.
• Lead co‑workers on design targeting based upon disparate data sources to identify members with likely risk gaps.
• Provide regular reporting of Risk Adjustment programs and identify opportunities and obstacles.
• Measure capture rate of Hierarchical Condition Categories (HCCs) and diagnosis codes related to Risk Adjustment programs to improve and optimize program targeting for Medicare and commercial exchange populations.
• Use Clinical Risk Group (CRG) software to target interventions for improved coding for Medicaid members.
• Calculate ROI for Risk Adjustment programs.
• Maintain regulatory requirements for CMS and NYS related to supplemental data.
• Minimal travel required.
• Perform other duties as assigned.

Work Arrangement

This position is hybrid to Schenectady or Rochester, requiring office presence two days a week/approximately eight times a month.

Qualifications

• Minimum Education: Bachelor’s Degree in Health Administration, Business, Economics, Health Informatics, or related field.
• Minimum Experience: 2years in a business environment involving analysis of financial or other large data sets. A Master’s Degree in a relevant field may be considered in lieu of this experience.
• Previous Health Insurance experience required.

Required Skills

• Ability to lead analytical projects and/or teams.
• Project Management.
• Demonstrated problem‑solving and analytical abilities.
• Intermediate SQL skills.
• Demonstrated ability to work independently with strong attention to detail.
• Ability to manage multiple projects and produce results within deliverable timelines.
• Demonstrated excellent written and verbal communication skills.
• Ability to transform analytical output into simple, understandable findings.
• Intermediate Word skills, including the ability to create moderately complex documents containing tables and graphs.
• Intermediate MicrosoftExcel skills, including the ability to create formulas, insert rows, link data, enter and sort data and produce graphs and charts.
• Proven ability to analyze, report, and provide insight on large sets of data.
• Data visualization skills (Tableau, PowerBI, etc.).
• Knowledge of MAO‑002, MAO‑004, and RAPS.
• Knowledge of CMS risk adjustment and reinsurance payment processes and audits for Medicare programs.
• Knowledge of revenue and data issues relating to CMS and NYS encounter submissions.
• Knowledge of ICD‑10, CPT, HCPCs, and Revenue Codes.

Preferred Skills

• R or Python.
• Clinical data analytics.

Benefits

• Paid time off (PTO), sick time, service‑time off, paid holidays, and floating holidays.
• Competitive 401(k) with employer matching and profit‑sharing.
• Low‑premium health benefits including medical, dental, and vision coverage.
• Life and disability insurance.
• Optional benefits such as accident insurance and specified disease coverage.
• Full tuition reimbursement (up to the IRS limit) for approved courses and programs.
• Employee Well‑Being program supporting all dimensions of health and wellness.

Equal Opportunity Employer

MVP Health Care is an affirmative action/equal employment opportunity employer. We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis. For special accommodations for the application process, contact Human Resources at [e-mail].