Medicare Risk Adjustment Analytics Advisor

Key Skills

Analytical and Problem solving, Data Analytics, Data science techniques, Effective communication skills, SQL, Tableau

Job Description

The Medicare Risk Adjustment Analytics Advisor would be a member of the Risk Adjustment and Enablement team that provides support by leveraging multiple data domains to answer important business questions. This position is connected with multiple teams to ensure that data is reviewed, explained and reported to measure success for Risk Adjustment Enablement projects. This position will have a primary focus on supporting Risk Adjustment compliance and audit projects.

Principal Duties:

• Perform required tracking and reporting for all Risk Adjustment overpayments including: identification, actuarial valuation, submission to CMS, processing by CMS, and reconciliation.

• Answering questions for external counsel and compliance partners to support overpayment reporting and managing reconciliation reporting of all requested risk adjustment deletes.

• Assists in the analysis and reporting solutions which address Risk Adjustment compliance and audit business needs.

• Identify and analyze user requirements, procedures and prepares detailed specifications from which analysis and reports will be written.

• Analyzes and revises existing reporting logic difficulties and documentation as necessary.

• Competent to work on any phase of the team Risk Adjustment analysis project activities.

• Leverage data and predictive analysis to clearly articulate problems and influence decisions that support the strategic direction.

• Communicate key information to Compliance and Audit partners for awareness of trends, processes, and Risk Adjustment issues.

• Working closely with Compliance, Audit, Actuary and other data domain leaders that share Risk Adjustment responsibilities.

• Reviewing, researching, investigating and correcting issues through data and process analysis.

• Develop collaborative relationships with internal partners to ensure Risk Adjustment goals are met.

• Analyze the integrity of data, diagnose issues and test changes.

• Participates in change management procedures to support accurate Risk Adjustment team documentation and process flows supporting processes and requirements.

• Maintain reporting describing results against internal goals; presenting results and updates to leadership.

• Resolve issues and problems by conferring with both internal and external partners as necessary.

• Other duties as assigned by supervisor/organizational leadership.

• Maintain professional contact with other departments as needed; attend interdepartmental meetings.

Qualifications Required:

• Bachelor's Degree required in Analytics, Data Science, Statistics, Applied Math, or related field.

• 6+ years of diverse work in a matrix Health Care environment.

• Expert knowledge and understanding of Claims, Encounters and Supplemental Data

• Expert knowledge of CMS rules and guidance for all aspects of Risk Adjustment submissions

• In-depth experience with various types and sources of Healthcare information; including Claim, Provider and Patient-level data.

• Excellent oral and written communication skills.

• Ability to achieve results independently and with a team.

• Strong analytical and creative problem-solving skills.

• Proficient with Microsoft SQL or like query writing programs.

• Proficient in root cause analysis and reporting.

• Experience in working on an Agile Development team.

• Proficient with SQL query writing.

• Familiar with SSRS, Tableau, or equivalent reporting applications.

• In-depth knowledge of healthcare terminology and practices

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an annual salary of 95,200 - 158,600 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group.

About Cigna Healthcare

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.