Job Details

Overview: Role will be responsible for risk adjustment model development, maintenance and optimization for Medicare, ACA and Medicaid lines of business. Data mining experience and skill will be essential. Role will be relied upon for collection, cleaning, exploration, transformation, enrichment, and monitoring of large volumes of healthcare data from disparate sources. Position will also be responsible for root cause analysis of any risk score anomalies, support of data risk adjustment tools and analytics environment and execution of data generation and reporting tasks.

Job Summary: This individual contributor is primarily responsible for driving strategic data-informed decisions, gathering data and information on targeted variables in an established systematic fashion, preparing data for analytic efforts, and interpreting data analyses. This position executes creative data analytic approaches leading to actionable outcomes, develops, implements, and automates business and reporting solutions, and develops analytical and/or statistical models enabling informed business decisions.

Essential Responsibilities:

• Practices self-development and promotes learning in others by proactively providing information, resources, advice, and expertise with coworkers and customers; building relationships with cross-functional stakeholders; influencing others through technical explanations and examples; adapting to competing demands and new responsibilities; listening and responding to, seeking, and addressing performance feedback; providing feedback to others; creating and executing plans to capitalize on strengths and develop weaknesses; supporting team collaboration; and adapting to and learning from change, difficulties, and feedback.
• Completes work assignments and supports business-specific projects by applying expertise in subject area; supporting the development of work plans to meet business priorities and deadlines; ensuring team follows all procedures and policies; coordinating resources to accomplish priorities and deadlines; collaborating cross-functionally to make effective business decisions; solving complex problems; escalating high priority issues or risks as appropriate; and recognizing and capitalizing on improvement opportunities.
• Executes creative data analytic approaches leading to actionable outcomes by defining and calculating metrics to be analyzed; defining, calculating, and validating algorithms; and conducting analyses, including descriptive, correlational, inferential, and/or predictive statistics.
• Develops, implements, and automates business and reporting solutions by working with stakeholders in their design, planning, and implementation while ensuring consistency and coherency; evaluating and summarizing data and results; creating summary statistics; developing data reports, visualizations, and/or interactive Business Intelligence (BI) reports; reporting to stakeholders on key findings; identifying needs for the development and implementation of additional reporting solutions; and preparing documentation as appropriate.
• Interprets data analyses by applying findings to contextual settings; and developing insights, reports, and presentations telling a compelling story to stakeholders to enable and influence decision making; and providing context related to data interpretations and/or limitations as appropriate.
• Drives strategic data-informed decisions by consulting with clients to identify and clarify key business needs; developing outcomes and process measures; translating business requirements; determining data/information needs and data collection methods; developing analysis plans; measuring the impact of business decisions on clients, customers, and/or members; working with clients and staff to identify opportunities and methods to improve efficiencies with analysis; supporting and training end-users; and documenting processes and deliverables.
• Gathers data and information on targeted variables in an established systematic fashion by validating data sources; querying, merging, and extracting data across sources; completing routine data refresh and update; developing and/or delivering tools for electronic data collection; and providing user training, support, and documentation.
• Develops analytical and/or statistical models enabling informed business decisions by determining data and analytical requirements; creating models leading to actionable insights; and testing, refining, and validating models.
• Prepares data for analytic efforts by integrating and consolidating data; ensuring data quality and accuracy; profiling data inaccuracies and recommending process improvements or system changes to enhance overall quality of the data; and cleaning and creating final data set(s) for analysis.

Minimum Qualifications:

• Minimum one (1) year experience in a leadership role with or without direct reports.
• Bachelors degree in Mathematics, Statistics, Engineering, Social/Physical/Life Science, Business, or related field and Minimum five (5) years experience in data analytics or a directly related field. Additional equivalent work experience in a directly related field may be substituted for the degree requirement.

Additional Requirements:

• Knowledge, Skills, and Abilities (KSAs): Negotiation; Business Planning; Written Communication; Data Extraction; Data Mining; Data Visualization Tools; Statistical Programming Language; Relational Database Management; Vendor Management; Project Management