Associate Director, Risk Adjustment Data and Analytics

Director of Risk Adjustment Data and Analytics The Role

Under the direction of the Senior Director 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 will oversee reporting, analytics and management of risk adjustment, both internally and externally. The role involves 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.

• Lead 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 and balancing 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 primary contact for facilitating resolution 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 subject matter knowledge, and improve 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 focus on technology, risk adjustment data and systems, or new projects

• Excellent knowledge of Medicare risk adjustment model
• Knowledge of Medicare and risk adjustment data and system interfaces required
• Proficiency in SAS/SQL; experience with other data analysis, extraction, and manipulation tools (e.g., Python, R), data visualization (e.g., Tableau) and analytic automation is preferred
• Demonstrated attention to detail, delivering quality results and collaborating as part of a team
• Experience 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 influence key internal constituents
• Documented strength in analysis, problem identification, and problem resolution
• Proven track record of meeting timelines, deliverables, 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

• Bachelor’s degree required;
  Master’s degree preferred
• Minimum of 7 years of Medicare risk adjustment experience
• Minimum 5 years of progressive leadership experience preferred
• Project Management and IT experience a plus
• Must be highly organized and capable of handling a multitude of projects at once

Boston, Hingham

Full time

37.5

Salary Range: $ – $

1

We offer a comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Blue Cross Blue Shield of Massachusetts is an Equal Employment Employer – veterans/disability. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or expression, or any other characteristics protected by law.