Resp & Qualifications
PURPOSE:
The Quality, Stars, and Risk Adjustment Analytics team is hiring a lead data analyst with deep experience in risk adjustment. This person will support the Director of Risk Adjustment by monitoring and reporting on risk adjustment KPIs, delivering insights for prospective and retrospective risk adjustment operational decisions, and working independently to improve process and data integrity. In addition, this person will work directly with vendors that supply additional data and reporting.
Note: We are looking for an experienced professional to live and work remotely from within the greater Baltimore/Washington metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities.
ESSENTIAL FUNCTIONS:
- Engages in data exploration using various programming languages (reading and writing code), requiring advanced knowledge of multiple database structures.
- Collect, analyze, and interpret data to glean insights, and develop business appropriate recommendations.
- Serve as an expert resource supporting data questions and issues from stakeholders and driving to resolution.
- Research and analyze data flow across complex data ecosystem including operational and analytical data platforms.
- Manage the collection of business and technical requirements from stakeholders to deliver data driven solution. Produces and reviews technical documentation that is consistent with professional standards.
- Lead in the design, development, validation and delivery of data to provide insight into business decisions.
- Act as a mentor to all team members.
SUPERVISORY RESPONSIBILITY:
Position does not have direct reports but is expected to assist in guiding and mentoring less experienced staff. May lead a team of matrixed resources.
QUALIFICATIONS:
Education Level: Bachelor's Degree in Data Science, Mathematics, Computer Science, Statistics, Business or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
Experience: 8 years experience in a progressively responsible analytical/quantitative role.
Preferred Qualifications:
- Experience in healthcare industry and deep understanding of Medicare risk adjustment (clinical, submission cycle, and financial experience).
- Strong experience with SQL, Power BI, and Excel.
- Skill with PowerPoint and experience presenting to a diverse set of stakeholders.
- Strong project management skills and ability to manage multiple and diverse stakeholders and leadership roles.
- Knowledge of claims data as found in back-end data warehouses.
- Experience with Fabric or Alteryx is a plus but not required.
Knowledge, Skills and Abilities (KSAs)
- Quantitative, analytical and problem-solving skills.
- Knowledge and understanding of analytical tools, languages, applications, platforms.
- Excellent communication skills both written and verbal.
- Ability to learn quickly and take direction.
- Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Salary Range: $97,056 - $192,764
Salary Range Disclaimer
The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).
Department
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
PHYSICAL DEMANDS:
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship
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