Risk Adjustment Analytics Sr. Analyst

Position: Risk Adjustment Analytics Sr. Analyst

Location: Boston, MA. Report to main campus in Boston, MA. Eligible to work remotely from anywhere in the U.S. but must report to the BMC campus 1 time/month.

Shift: Day Shift

Schedule: Full Time

Essential Responsibilities and Duties:

• Report to the Executive Director of System Analytics and lead the analytics for risk adjustment for BMCHP's products, including Massachusetts and New Hampshire Medicaid, ACA, and Medicare lines of business in order to sustain the profitability of health plan products and ensure the system has adequate funding to invest in new patient care and programs.
• Support both retrospective and prospective risk coding efforts in order to identify coding gaps and develop approaches to address them.
• Use novel analytics to identify holistic opportunities to ensure accurate and complete risk coding for our products and drive decision-making of senior management.
• Work with risk adjustment models for Medicaid, ACA, and Medicare lines of business, including HSS-HCC, CMS-HCC, DXCG, and CDPS models used by payers.
• Develop analytics to identify opportunities for retrospective risk coding for each product line, based on coding gaps, pharmacy claims, lab data, EMR data, and other approaches.
• May apply advanced techniques (e.g., machine learning) working with Data Science division.
• Produce risk gap lists for our risk coding operations team to support chart chase and retro coding operations.
• Develop dashboards to track monthly risk scores for each line of business, and identify segments of the population (by risk group, conditions, provider groups, etc. where intervention may be required.
• Develop standardized approaches to measure impact of both retrospective and prospective risk coding programs.
• Perform root cause analysis of risk coding gaps, including working with coding team to review EMR records to determine causes for lack of gap closure.
• Work closely with risk coding partner vendors to integrate data and learn to adapt their tools.
• Work closely with BMCHP and BMC IT teams to resolve data issues, develop data specifications, and transfer data.
• Work directly with ACO provider partners to present findings and help solve risk coding gaps.
• Query the BMCHP profitability database to identify clusters of members with total cost of care in excess of risk-adjusted revenue.
• Research and adapt best practices of risk coding from other healthcare organizations.
• Translate complex analysis into simple visualizations that can communicate key takeaways to leaders and stakeholders.

• Understand health system data sources and support data architecture team to ensure that data is clean, normalized, and accurate.
• Present analyses to senior leaders and ACO partners and provider sites.

Job Requirements

Education:

• Bachelor's degree in Operations Research, Data Analytics, or analytically-related field.

Experience:

• Must have 3 years of experience in the job offered or 3 years of analytics experience in the U.S. healthcare risk adjustment analytics field either at a health plan or vendor serving health plans. The stated experience must include 1 year with the following: (1) using CMS risk adjustment models, either HHS-HCCs and/or CMS-HCCs; (2) working with data science in a healthcare capacity.
• Must have 2 years of experience using SQL, Tableau, and Excel (may be gained concurrently or separately).