Associate Director, Risk Adjustment Data and Analytics

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The Role

Director of Risk Adjustment Data and Analytics

Under the direction of the Senior Directory of Medicare Risk Adjustment and Analytics, the Director of Risk Adjustment Data and Analytics is responsible for developing and executing the analytic plan for the Medicare and Merged Market segments. The Director of Risk Adjustment Data and Analytics will oversee the reporting, analytics and management of risk adjustment, internally and externally. The role is responsible for the strategy, execution and performance of Medicare risk adjustment reporting and analytics, infrastructure and systems to meet business objectives, partnership with Actuarial and Provider Contracting, management of external vendors, and compliance with CMS regulations.

This leader is responsible for analysis, projections, and assessment of risk adjustment performance.

RESPONSIBILITIES:

* Responsible for direct leadership of the Risk Adjustment Performance and Strategic Analytics Team and the Risk Adjustment Data and Analytics Team

* Design and develop metrics, reports, and dashboards to drive key strategic and tactical decisions, ensuring alignment of resources as needed, and balance workloads

* Coordinate risk adjustment analytics throughout the broader organization

* Investigate risk adjustment trends across all areas including enrollment, providers and claims to suggest business improvements and efficiencies

* Represent the Risk Adjustment Team on internal work groups and committees focused on reporting, analytics, and operations

* Ensure business deliverables are being met and risk adjustment data is provided to Government Programs leaders and internal business leaders to inform strategic initiatives

* Act as the primary contact for facilitating resolution (via analysis and reporting) on urgent issues and/or issues escalated by risk adjustment leaders.

* Drive innovation and improvements through deep dive analytics; improve risk adjustment processes; increase efficiency and productivity and improve overall plan performance

* Oversee the assessment of reporting requests, compilation, and distribution of routine and ad hoc reports for internal and external constituents

* Coach, mentor, and develop analytic team members to increase their skill sets, enhance their subject matter knowledge, and improve their effectiveness to support other business areas

* Oversee submission of BCBSMA's Encounter Data submission to CMS and resolution of errors

* Represent the Risk Adjustment Team's interests through influence and negotiation in cross-functional work groups that have a technology focus, are strategic around risk adjustment data and systems, or pertain to new projects.

QUALIFICATIONS:

* Excellent knowledge of Medicare risk adjustment model

* Knowledge of Medicare and risk adjustment data and system interfaces required

* SAS/SQL experience required. Other experience with the use of software for data analysis, extraction, and manipulation (e.g., Python, R), data visualization (e.g., Tableau) and analytic automation (e.g. scripting, macros) preferred

* Demonstrated attention to detail, delivering quality results and operating collaboratively as part of a team

* Experience in managing technology-related projects with vendors, IT and corporate partners

* Proven success in managing people and achieving business goals and objectives

* Ability to develop strong working relationships and to influence key internal constituents to

* Documented strength in analysis, identification of problems, and problem resolution

* Proven track record of meeting timelines, deliverables, attention to detail and quality results

* Strong organizational skills with ability to work under pressure, multitask and prioritize workload

* Ability to identify, communicate, and manage risk

* Effective presentation, facilitation, project management and planning skills

EDUCATION/RELEVANT

EXPERIENCE:

* Bachelor's degree required;
Master's degree preferred

* A minimum of 7 years of Medicare risk adjustment experience

* Minimum 5 years of progressive leadership experience preferred

* Project Management and IT experience a plus

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