Strategic Risk Adjustment Analytics Lead

EmblemHealth; New York (NY); On-site; USD 78,000 - 149,000; Full time

Job summary

EmblemHealth is leading the development of a risk adjustment data modeling and analytics tool to support CMS-HCC, HHS-HCC, RX-HCC and CRG submissions for MA and ACA plans. The role focuses on data optimization and forecasting to improve efficiency across Risk Adjustment programs.

The candidate will partner with leadership, vendors and enterprise leaders to ensure workflow alignment from Risk Adjustment to interdependencies, with a strong emphasis on model validation and cost containment

Qualifications

• Bachelor's Degree required.
• Master's Degree in Health or Business Administration preferred.
• 5–8+ years of related, professional work experience required.
• Experience with Government Sponsored Health Plans required.
• Experience with Risk Adjustment Modeling, Bid Submissions with vendors required.
• Experience in a managed care environment preferred.
• Proficiency with SQL, Python, SAS required.
• Proficiency with Microsoft Word, Excel, PowerPoint, Outlook, Teams required.
• Detail oriented with strong communication and negotiation skills.

Responsibilities

• Lead the development of CMS-HCC, HHS-HCC models and analytics for MA and ACA plans.
• Forecast vendor spend, premium revenue and efficiency of Risk Adjustment programs.
• Deliver modeling outputs to guide vendor deployment and reporting on efficacy.
• Collaborate with external vendors to gain market insights for NYS Medicaid.
• Partner with Actuarial on model validation and revenue forecasting.
• Track progress and communicate project status to stakeholders.
• Develop and refine program management oversight for successful delivery.
• Report progress to Enterprise Risk Adjustment leadership and leadership teams.

Skills

SQL

Python

SAS

Communication skills

Detail oriented

Education

Bachelor's Degree

Master's Degree in Health or Business Administration (Preferred)

Tools

Microsoft Word

Microsoft Excel

PowerPoint

Outlook

Teams

Job description

EmblemHealth is leading the development of a risk adjustment data modeling and analytics tool to support CMS-HCC, HHS-HCC, RX-HCC and CRG submissions for MA and ACA plans. The role focuses on data optimization and forecasting to improve efficiency across Risk Adjustment programs.

The candidate will partner with leadership, vendors and enterprise leaders to ensure workflow alignment from Risk Adjustment to interdependencies, with a strong emphasis on model validation and cost containment