Senior Risk Adjustment Data Analyst

The Alliance; Bakersfield (CA); Hybrid; USD 88,000 - 142,000; Full time

Job summary

Join a leading health plan as a Senior Risk Adjustment Data Analyst, where you'll perform in-depth data analysis and reporting, lead projects, and collaborate with various teams to enhance healthcare outcomes. This hybrid role is pivotal in ensuring accurate coding and reimbursement within Medicare programs, utilizing your expertise in SQL and data visualization. You'll be part of a dedicated team committed to improving community health through data-driven insights.

Benefits

Medical, Dental and Vision Plans

Ample Paid Time Off

12 Paid Holidays per year

401(a) Retirement Plan

457 Deferred Compensation Plan

Robust Health and Wellness Program

Onsite EV Charging Stations

Qualifications

• Minimum of five years experience in healthcare finance reporting and analytics.
• Three years experience in a Medicare environment.

Responsibilities

• Perform complex analytical data mining and reporting.
• Lead initiatives and provide program support related to data gathering and analysis.

Skills

Risk Adjustment Methodologies

SQL

Data Visualization

Collaboration

Education

Bachelor’s degree in Finance

Bachelor’s degree in Business

Bachelor’s degree in Information Technology

Tools

Tableau

Job description

We have an opportunity to join the Alliance as a Senior Risk Adjustment Data Analyst in the Risk Adjustment Department.

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the Risk Adjustment Director, this position will perform complex analytical data mining and reporting in support of the Risk Adjustment Department. You will also lead initiatives, provide program support, and perform project management related to data gathering and analysis as well as act as a subject matter expert and resource regarding risk adjustment data.

ABOUT THE TEAM

Risk Adjustment is a growing, specialized team that plays a critical role in ensuring accurate coding, appropriate reimbursement and data-driven insights that support the broader organizational goals of our health plan. Our team collaborates closely with internal and external partners to optimize risk adjustment performance across our future Medicare and current Medi-Cal programs. We are passionate about using data to improve our members' health outcomes, support the success of our provider partners, and ensure regulatory alignment.

THE IDEAL CANDIDATE

• Well versed in risk adjustment methodologies, particularly within the Medicare space
• Familiarity with risk adjustment models and their impact on plan performance and payment
• Proficiency in SQL, and an ability to analyze and translate complex healthcare data into meaningful and actionable insights, in addition to general reporting
• Experience with data visualization tools to present insights clearly and effectively
• Self-directed and proactive, with the ability to manage priorities and drive projects forward
• Strong collaborator who can work effectively with organizational teams, including IT, finance, operations, clinical and compliance teams

WHAT YOU'LL NEED TO BE SUCCESSFUL

To read the full position description, and list of requirementsclick here .

• Knowledge of:
• Quantitative data analysis methodologies and analytical tools related to risk adjustment reporting and analysis
• Data modeling techniques and business analytical and data mining tools, including SQL, and data visualization tools, such as Tableau
• Medicare program and related regulations
• Medicare (Hierarchical Condition Categories) risk adjustment models
• Methods and techniques of developing and delivering data management strategies that support contract analysis, trend management, budgeting, forecasting, strategic planning, and healthcare operations
• Ability to:
  • Collect, interpret, and evaluate data, detect patterns, brainstorm solutions, consider multiple factors when making decisions, and project consequences of recommendations
  • Perform technical and non-technical troubleshooting and diagnose and resolve complex problems, including problems that may have multiple variables and may not have obvious solutions
  • Act as a technical resource, provide guidance related to area of assignment, and explain related regulations, processes, and programs
  • Work collaboratively and productively with diverse project teams in order to achieve efficient and timely solutions
• Education and Experience:
  • Bachelor’s degree in Finance, Business, Information Technology, or a related field
  • A minimum of five years of experience performing health care finance reporting and analytics, including a minimum of three years of experience working in a Medicare environment (a Master’s degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying.

OTHER INFORMATION

• We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.
• While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
• In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.

The full compensation range for this position is listed by location below.

The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).

Typical areas in Zone 1: Bay Area, Sacramento, Los Angeles area, San Diego area

Typical areas in Zone 2: Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka area

Zone 1 (Monterey, San Benito and Santa Cruz)

$96,979 — $155,168 USD

Zone 2 (Mariposa and Merced)

$88,251 — $141,211 USD

OUR BENEFITS

Available for all regular Alliance employees working more than 30 hours per week.Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance.

• Medical, Dental and Vision Plans
• Ample Paid Time Off
• 12 Paid Holidays per year
• 401(a) Retirement Plan
• 457 Deferred Compensation Plan
• Robust Health and Wellness Program
• Onsite EV Charging Stations

ABOUT US

We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.

Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at ourFact Sheet .

The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer

At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

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