Note: The job is a remote job and is open to candidates in USA. CareFirst BlueCross BlueShield is seeking a Senior Data Risk Adjustment Analyst to support its Health Services Risk Adjustment team. The role develops and maintains data assets, performs advanced healthcare data analysis, creates dashboards and reporting solutions, supports forecasting and targeting methodologies, and partners with clinical, operational, financial, and technology stakeholders to improve program performance and regulatory compliance.
Responsibilities
- Perform advanced data exploration, analysis, and solution development using programming languages and analytical tools to support Risk Adjustment initiatives. Leverage expertise across complex healthcare data structures including claims, encounters, provider, member, and risk adjustment data sources to identify trends, coding opportunities, and program improvement strategies
- Collect, analyze, and interpret Risk Adjustment data to generate actionable insights and recommendations that improve risk score accuracy, program performance, financial outcomes, and regulatory compliance
- Research, validate, and analyze data flow across operational and analytical ecosystems to ensure the integrity, completeness, and traceability of Risk Adjustment data used for reporting, forecasting, reconciliations, and regulatory submissions
- Serve as a subject matter resource for Risk Adjustment analytics, supporting stakeholders with data inquiries, business questions, and issue resolution related to risk scores, coding initiatives, program performance, and regulatory reporting
- Lead the design, development, testing, validation, and delivery of analytical solutions, dashboards, and reporting that support Risk Adjustment strategy, targeting initiatives, operational decision-making, and program effectiveness measurement
- Partner with business and technical stakeholders to gather requirements and deliver data-driven solutions supporting Medicare, Medicaid, and ACA Risk Adjustment programs. Develop and maintain technical documentation, business requirements, data specifications, and process documentation consistent with organizational standards
Skills
- **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:** 5 years experience in an analytical/quantitative role
- * 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
- The ideal candidate will possess strong analytical and problem-solving skills, experience working with large healthcare datasets, and a solid understanding of Medicare Advantage, ACA, and Medicaid risk adjustment methodologies
- 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
- 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
- Must be eligible to work in the U.S. without Sponsorship
- * Experience in Healthcare Industry
- * Hands-on experience with Big Data/NoSQL Platforms with experience delivering production projects at scale
- * Proficiency with SQL, Power Bi, Fabric, Python, and/or SSMS
Benefits
- CareFirst offers a comprehensive benefits package.
- Various incentive programs/plans, subject to eligibility requirements.
- 401k contribution programs/plans, subject to eligibility requirements.
- Remote work from within the greater Baltimore/Washington metropolitan area.
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