Director, RADV Program Analytics & Risk Reporting

Overview

Alignment Health is a fast‑growing company committed to serving seniors, the chronically ill, and the frail. We bring a passionate, caring team united in our mission to put seniors first. In this dynamic environment, you will find ample room for growth and innovation alongside the Alignment Health community.

• Cross‑functional collaboration:
  Work closely with Risk Adjustment Operations, Finance, DTS, Compliance, and other departments to ensure accurate data for financial risk modeling.
• Data governance and integrity:
  Ensure the integrity of all risk adjustment and HCC related metrics.
• Translate business requirements into specifications for BI solutions and dashboards.
• Data engineering collaboration:
  Work with data engineers to tune data sets feeding the analytics platforms for optimal performance.
• Standardized and ad‑hoc analytics:
  Define and improve standardized and ad‑hoc analytics/reporting capabilities.
• Stored procedures:
  Design, develop, and optimize stored procedures to meet data management and reporting objectives.
• Reconciliation:
  Oversee the reconciliation of audited HCCs against submitted claims data and standard CMS files.
• Direct analysts:
  Direct analysts in data validation, dashboard development, and audit metrics reporting.
• Audit trend analysis:
  Present audit trend analysis to leadership and regulatory committees.
• Metrics tracking:
  Track progress and performance metrics; elevate risks to leadership as needed.
• Standard operating procedures:
  Develop and maintain SOPs & P&Ps for CMS HCC/risk adjustment models and RADV analytics workflows.
• Performance management tools:
  Evaluate, implement, and optimize performance management and analytics tools to streamline processes and improve user experience.

• Hiring, performance management, and staff development.
• Develop and implement policies and programs.
• Budgetary responsibilities as required.

Required:

Minimum 7 years of data science experience, including at least 5 years in a leadership role managing data science teams.
Preferred:
Experience in a large health system.

• Required:
  
  Bachelor's degree in computer science, IT, or equivalent experience.
• Preferred:
  Microsoft SQL Server, Power BI, Python, or Azure certification/experience.

• Extensive experience working with large, complex data sets, including clinical and healthcare data, and proficiency in data integration from various sources.

None specified.

• Regularly required to talk or hear, stand, walk, sit, use hands to finger, handle or feel objects, tools, or controls, and reach with hands and arms.
• Frequently lifts and/or moves up to 10 pounds.

Pay Range: $ – $

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.