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Senior or Principal Healthcare Risk Adjustment Data Analyst

Hybrid | Eagan, Minnesota
Job ID: R0004365 Career Area: Data Analytics & Business Intelligence Date Posted: 01/29/2024
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About Blue Cross

Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We’re committed to reinventing health care to improve health for our members and the community. We hope you'll join us.

This position is posted at a hierarchy and can be hired at either the Senior Healthcare Risk Adjustment Analyst level or Principal Healthcare Risk Adjustment Analyst level. The identified candidate will be hired at a level commensurate with their skills.

Senior Healthcare Risk Adjustment Analyst

How Is This Role Important to Our Work?


This position supports Enterprise Risk Adjustment, a newly-created organization responsible for optimizing risk adjustment revenue through closing gaps in coding and care delivery across Blue Cross Medicare, Medicaid, and Exchange populations.Specifically, this position is responsible for business intelligence and analytics related to Enterprise Risk Adjustment.This position uses business intelligence, analytic, and data science techniques to improve risk adjustment results for these populations. This includes obtaining data from various internal sources, understanding relevant differences between each data source, designing and structuring files for analysis, and performing and interpreting descriptive, bivariate, and multivariate analyses.This position also will also be responsible for designing, conducting, and communicating analytics and research projects that support Enterprise Risk Adjustment.Content areas for this position will span:ERA Program Analytics: Answers the question of whether we are focused on the right members, the right types of gaps in coding and care, how much we have accomplished, what opportunities remain, and estimates the value of those opportunities in order to drive risk adjustment strategy and meet our revenue targets.Intervention and Pilot Test Analytics: Analytic and measurement support to inform pilot test/intervention design to ensure rigor in outcomes evaluation; evaluate pilot tests/interventions with respect to gap closure and ROI; and inform decisions about pilot/intervention modification and scale-up.Provider-Focused Analytics: Analytic and reporting support to understand provider performance on gaps in coding and care delivery and enable provider coaching.The Senior Healthcare Analyst analyzes complex data and information to provide meaningful results, identifying success factors and improvement opportunities, suggesting potential solutions, and helping internal customers set strategic directions.The position should bring proven data analytics skills and a spirit of creativity and problem-solving to deepen insights into the factors that drive health care quality.The Senior Healthcare Analyst filling this position must be highly skilled from project design through implementation and have strong communication skills.The Senior Healthcare Analyst will work collaboratively in a team environment.

A Day in the Life:

  • Develops and works with structured data files from multiple internal sources, such as enrollment data, clinical and pharmacy claims data, risk adjustment data, and other types of data.
  • Independently manages the retrieval of data from a healthcare data warehouse and other sources.
  • Uses business intelligence, statistical, and/or data science techniques to analyze data to guide and evaluation risk adjustment activities.
  • Identifies issues to be investigated and leads or works collaboratively to define and implement a solution.
  • Clearly collaborates and communicates results to non-technical audiences, including producing easy-to-understand representation of the results.
  • Serves as a consultant who can explain complex analytic concepts, techniques, and results in non-technical terms.
  • Collaborates with other analytic areas within Blue Cross, especially Actuarial.
  • Produces regular and ad-hoc reports for business stakeholders to enable risk adjustment optimization across multiple lines of business.
  • Reports results on risk adjustment-related outcomes, identifies needs and opportunities for improvement, and interprets results for stakeholders.
  • Initiates action to discover new data collection opportunities, new ways to leverage existing data, or new analyses that will contribute to the ability of Enterprise Risk Adjustment to play a more strategic role in exceeding outcomes.

Nice to Have:

  • Bachelor's degree.
  • Masters degree preferred.
  • Knowledge of managed care and health care claims preferred.

Required Skills and Experiences:

  • 5+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
  • 2 years of experience using various statistical software and computer programming (e.g., SAS, R, Python, SQL, Visual Basic, DB2, Oracle, etc.) - OR- requires advanced understanding/experience with multiple programming languages, systems, systems design and/or software development methodologies.
  • Proficiency in Microsoft software applications such as Word, PowerPoint, Excel, Access.
  • Ability to perform validation techniques, as well as perform and interpret a variety of statistical analyses.
  • Demonstrated ability to design, evaluate and interpret complex data sets.
  • Demonstrated ability to handle multiple tasks with competing priorities.
  • Demonstrated analytic and problem solving skills.
  • Excellent written and verbal communication skills and with an ability to interpret and communicate analytical information to both individuals and groups in a clear and concise manner.
  • Demonstrated ability to present complex technical information to non-technical audiences and to senior decision-makers.
  • Demonstrated ability to work effectively both independently and in a team setting with individuals having diverse professional backgrounds including business, technical and/or clinical.

Principal Healthcare Risk Adjustment Analyst

How Is This Role Important to Our Work?


This position will support Enterprise Risk Adjustment (ERA), a Stella Program responsible for optimizing risk adjustment revenue through closing gaps and risks in coding and care delivery across Blue Cross' Medicare, Medicaid, and ACA populations. Specifically, this position is responsible for business intelligence and analytics related to Enterprise Risk Adjustment. The applicant will achieve success using a combination of traits and skills including industry knowledge of risk assessment and risk adjustment knowledge domains, data and programming savvy, math and statistical abilities, and a spirit of creativity and problem-solving to deepen insights into the factors that drive health care quality and risk adjustment outcomes. A successful applicant will work independently as well as collaboratively with cross-functional teams to initiate, plan, and lead analysis from conceptual development to conclusion. The position will lead efforts with coworkers, internal business partners, and leadership to clarify requirements, analyze complex data, and produce and present meaningful and defensible results, including the identification of success factors and barriers, improvement opportunities, proposing solutions, and informing strategic decisions. The individual will also drive action based on the results obtained. The Risk Adjustment Data Analyst Pr will represent the department on both internal and external initiatives. They may also lead project teams. The incumbent will lead efforts to define meaningful contributions that will influence strategic decision-making and the optimization of Stars/Risk/Quality analytics at Blue Cross Blue Shield of Minnesota.

A Day in the Life:

  • Develops and works with structured data files from multiple internal sources, such as enrollment data, clinical and pharmacy claims data, risk adjustment data, and other types of data.
  • Uses business intelligence, statistical, and/or data science techniques to analyze data to guide and evaluation risk adjustment activities.
  • Identifies issues to be investigated and leads or works collaboratively to define and implement a solution.
  • Clearly collaborates and communicates results to non-technical audiences, including producing easy-to-understand representation of the results.
  • Serves as a consultant who can explain complex analytic concepts, techniques, and results in non-technical terms.
  • Collaborates with other analytic areas within Blue Cross, especially Actuarial and Risk Adjustment / Quality Operations.
  • Produces regular and ad-hoc reports for business stakeholders to enable risk adjustment optimization across multiple lines of business.
  • Reports results on risk adjustment-related outcomes, identifies needs and opportunities for improvement, and interprets results for stakeholders.
  • Initiates action to discover new data collection opportunities, new ways to leverage existing data, or new analyses that will contribute to the ability of Enterprise Risk Adjustment to play a more strategic role in exceeding outcomes.

Nice to Have:

  • Masters degree or ASA/FSA preferred.
  • Knowledge of Tableau or other data visualization software preferred, with expertise or an interest in developing programming skills
  • Demonstrated understanding of predictive & regression model development and application to risk adjustment.
  • Experience in data science model development and maintenance (e.g. feature engineering, logistic regression, decision trees, testing/validation)

Required Skills and Experiences:

  • 7+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
  • Knowledge & understanding of risk adjustment in healthcare including common risk adjustment models (e.g. CMS-HCC, HHS-HCC, CDPS)
  • 5 years experience analyzing and modeling data involving outcomes and utilization, using various statistical software and computer programming (SAS, Visual Basic, DB2, Oracle, etc.).
  • Proficiency in Microsoft software applications such as Word, PowerPoint, Excel, Access.
  • Demonstrated ability to design, evaluate and interpret complex data sets.
  • Demonstrated ability to handle multiple tasks with competing priorities.
  • Demonstrated analytic and problems solving skills.
  • Excellent written and verbal communication skills, with the ability to interpret and communicate analytical information to both individuals and groups in a clear and concise manner.
  • Demonstrated ability to present complex technical information to non-technical audiences and to senior decision-makers.
  • Demonstrated ability to work effectively both independently and in a team setting with individuals having diverse professional backgrounds including business, technical and/clinical.
Make A Difference

Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.

Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.

All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.

Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.
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