Risk Score Data Analyst
Please mention DailyRemote when applying
AI Summary
The analyst provides primary analytic and operational support to the Risk Score Management program to improve member risk profile accuracy. Responsibilities include producing risk adjustment reports, managing projects, and collaborating with internal departments and external vendors.
Site: Mass General Brigham Health Plan Holding Company, Inc.
Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills.
We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more.
This is an ideal candidate for a mid-career changer hoping to get into healthcare or an entry-level candidate with some experience in analytics.
This role is responsible for providing primary analytic and operational support to the Risk Score Management program with the objective of improving the accuracy of member risk profiles. This analyst will develop and produce reports based on risk adjustment data from several data sources, work with both internal and external departments to identify opportunities for risk score improvement, and manage multiple risk score projects. The position will be responsible for targeted member tracking for medical record audits and outreach, vendor management, and provider engagement. This analyst may also be required at times to lead analytic projects with minimal supervision and work cross-functionally with various departments such as Actuarial, Finance, Medical Economics, and Clinical.
Essential Functions
-Creates and produces risk adjustment analyses for the Risk Score department, senior leadership, and internal and external customers.
-Analyze claims and membership data to identify trends and patterns using Excel/SQL/SAS, etc.
-Completes ad-hoc analyses to support internal and external customers.
-Evaluates data quality of internal and external datasets.
-Participates in various departmental projects operationally and analytically such as vendor-assisted chart reviews, audits and in-home medical assessments.
-Anticipates and meets, or exceeds, internal and/or external customer expectations and requirements; establishes and maintains effective relationships with internal and external customers and gains their trust and respect.
-Tracks deliverables and action items across internal departments and vendors to keep projects moving.
-Monitors CMS and MassHealth risk adjustment policy and guidance and summarizes operational implications for the department.Remote399 Revolution Drive40RegularDay (United States of America)8925 Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.
Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills.
We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more.
This is an ideal candidate for a mid-career changer hoping to get into healthcare or an entry-level candidate with some experience in analytics.
This role is responsible for providing primary analytic and operational support to the Risk Score Management program with the objective of improving the accuracy of member risk profiles. This analyst will develop and produce reports based on risk adjustment data from several data sources, work with both internal and external departments to identify opportunities for risk score improvement, and manage multiple risk score projects. The position will be responsible for targeted member tracking for medical record audits and outreach, vendor management, and provider engagement. This analyst may also be required at times to lead analytic projects with minimal supervision and work cross-functionally with various departments such as Actuarial, Finance, Medical Economics, and Clinical.
Essential Functions
-Creates and produces risk adjustment analyses for the Risk Score department, senior leadership, and internal and external customers.
-Analyze claims and membership data to identify trends and patterns using Excel/SQL/SAS, etc.
-Completes ad-hoc analyses to support internal and external customers.
-Evaluates data quality of internal and external datasets.
-Participates in various departmental projects operationally and analytically such as vendor-assisted chart reviews, audits and in-home medical assessments.
-Anticipates and meets, or exceeds, internal and/or external customer expectations and requirements; establishes and maintains effective relationships with internal and external customers and gains their trust and respect.
-Tracks deliverables and action items across internal departments and vendors to keep projects moving.
-Monitors CMS and MassHealth risk adjustment policy and guidance and summarizes operational implications for the department.
Qualifications
Education
- Bachelor's Degree required
Experience
- Data analysis experience preferred
Knowledge, Skills, and Abilities
- Strong analytical skills, including basic SQL, SAS, or advanced Excel.
- Excellent verbal and written communication skills.
- Creative, flexible, self-directed, and self-motivated with sound judgment and critical thinking.
- Accountable for delivering high-quality work.
- Organizational and project management skills to manage projects effectively.
- Interest in government healthcare programs (Medicare, Medicaid).
- Strong in drafting briefings and presentations for internal and external use.
Additional Job Details (if applicable)
Working Conditions
- This is a remote role that can be done from most US states with a strong preference for local candidates who could attend occassional in-person meetings
- This is a Monday-Friday role with standard business hours (in Eastern time)
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$63,648.00 - $92,570.40/Annual
Grade
6
EEO Statement:
Mass General Brigham Competency Framework
At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
Automatically Apply to the Best Remote Jobs
Stop the endless job search. Our AI finds and applies to the best jobs for you.
