Data Analyst at Bright Health
- Complete data analyses focused on risk adjustment for Individual & Family Plans, Medicare Advantage, and other product lines. Performs data and analytical services in support of ensuring appropriate risk-adjusted revenue, maintaining compliance with CMS standards and modeling financial impacts of changes in risk adjustment data and methodologies.
- Support the development and implementation of best-in-class tools and capabilities to support efforts such as identification of diagnostic suspects, data reconciliations to limit data leakage, and drive bi-directional gap closure efforts.
- Integrate with internal business partners, share market/provider-specific insights and drivers to support engagement with care delivery partners on risk adjustment initiatives.
- Collaborate with business stakeholders to understand analytics needs, develop plans to address those needs, and analyze and interpret data to provide insights.
- Bring together multiple sources of complex data to design and develop reports that answer a business question.
- Understands and incorporates quality principles to ensure optimal performance of Risk Adjustment Submissions processes.
- Maintains current knowledge of CMS' Hierarchical Condition Categories (HCC) and Prescription Drug Risk Adjustment codes (RxHCCs) including risk adjustment values and formulas.
- Create reporting resources and datasets that are well designed, easily maintained, and repeatable.
- Produce clear and concise summaries of analytical findings for consumption by a variety of audiences through a range of media: presentations, email summaries, executive summaries, and oral discussions.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- Bachelor’s degree in analytics-related field or ten (10) or more years of professional experience required
- Two (2) or more years of analytics experience required
- Two (2) or more years of health care industry experience required
- Experience working with medical or pharmacy claims required
- Experience with risk adjustment analytics preferred
- Experience with either SQL and/or SAS to capture, manipulate, and summarize data
- Dedicates exacting attention to detail and data quality
- Eager learner, collaborative partner, easy communicator, and careful analyst
- Passion for empirical research and answering hard questions with data
- Willingness to mentor other team members and advance their knowledge