The Senior Risk Adjustment analyst will assist with the workload associated with OptumCare's newer markets and will help process new data related to our Medicare revenue forecasts.
Perform analysis and reporting activities relating to: risk score calculation, claims/encounters data submission, chart review programs and audits, and related performance metrics.
Analysis and reporting on RAF Forecast Model and risk adjusted revenue PMPM by plan/patient cohorts and review cost and utilization trends to understand impact on revenue; along with reconciliation and root cause analysis for any variance.
Analysis and reporting of revenue results to assist financial reporting, forecasting and budget development.
Design and develop dashboard for reporting related to Risk Adjustment and Senior Revenue Finance.
Analysis and reporting on HCC program initiatives relative to benchmarks/targets.
Analysis and reporting on CMS data like MMR and MOR received through various health plans.
Develop tools and conduct analysis to evaluate accuracy and completeness of encounter exchange with capitated providers.
Work with EDI team to ensure timely and accurate encounter submissions to health plans and other state or federal agencies. Analyze the financial impact of data issues and encounter rejection buckets.
Communicate and collaborate with internal and external stakeholders on risk adjustment related analysis, knowledge or both.
Comply with HIPAA Regulations and company compliance policy.
Stay updated and share knowledge on industry changes especially any changes on CMS side (changes like ICD10, EDS, Payment Model Changes)
Bachelors degree from a four-year college required; preferred: major in information systems or related quantitative field (finance, computer science or, mathematics).
5+ years of analytics experience.
Strong understanding of Risk Adjustment Payment Model and Cycle including the knowledge base to calculate and manipulate risk scores.
Experience with Risk Score and Revenue forecast is a plus.
Deep familiarity with CMS data and risk adjustment processes including MMR, MOR and EDS data.
Strong understanding of Claims and Encounter data.
Strong command on SQL Server (T-SQL), SSIS and SSRS, and Database design.
Strong analytical/financial skills
Proficient with MS Office, MS-Access, MS-Visio
What's the first thing that happens when one of the leading independent medical groups in the country comes together with a global leader in health care? Opportunity. With DaVita Medical Group, HealthCare Partners, The Everett Clinic, Northwest Physicians Network, MountainView Medical Group and Magan Medical Clinic joining OptumCare and the UnitedHealth Group family of companies, people like you will find increasing levels of challenge, impact and professional success. We're changing health care for the better by improving access to affordable, high quality care, and working together to improve the patient experience. That takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment. Are you with us? Learn more about this exciting opportunity to do your life's best work.(SM)
Careers with OptumCare. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. OptumCare, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Here youll find incredible ideas in one incredible company and a singular opportunity to do your life's best work.(SM)
Diversity creates a healthier atmosphere: OptumCare and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. OptumCare and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.