Risk Adjustment Analytics Manager
Apply NowCompany: Cano Health
Location: Miami, FL 33186
Description:
It's rewarding to be on a team of people that truly believe in making an impact!
We are committed to building the best primary care environment for patients and are seeking healthcare enthusiasts to join us.
Job Summary
We are looking for a Risk Adjustment Analytics Manager to support the Medicare, Medicaid and Qualified Health Plan ("Exchange") populations. As a Risk Adjustment Analytics Manager, you will develop strategies to ensure risk adjustment data accuracy, coordinate the work of clinical and operations partners, and respond to new requirements from CMS or company leadership. You will prepare performance reporting and analyze the success of various risk adjustment strategies.
Essential Duties & Responsibilities
Education & Experience
Education Requirements
Required/Preferred
Education Level
Discipline
Required
Bachelor's
Knowledge, Skills & Proficiencies
Physical Requirements
This position works under usual office conditions. The associate is required to work at a personal computer as well as be on the phone for extended periods of time. Must be able to stand, sit, walk, and occasionally climb. The incumbent must be able to work extended and flexible hours and weekends as needed. Physical demands include ability to lift up to 50 lbs. The physical demands described here are representative of those that must be met by the associate to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Work Conditions
Must be able to perform essential functions such as typing, standing, sitting, stooping, and occasionally climbing
Travel Requirements
Travel Required
Amount of Expected Travel
Details
No
Tools & Equipment Used
Computer and peripherals, standard and customized software applications and tools, and usual office equipment
Disclaimer
The duties and responsibilities described above are designed to indicate the general nature and level of work performed by associates within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of associates assigned to this job. This is not an all-inclusive job description; therefore, management has the right to assign or reassign schedules, duties, and responsibilities to this job at any time. Cano Health is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.
Join our team that is making a difference!
Please see Cano Health's Notice of E-Verify Participation and the Right to Work post here
We are committed to building the best primary care environment for patients and are seeking healthcare enthusiasts to join us.
Job Summary
We are looking for a Risk Adjustment Analytics Manager to support the Medicare, Medicaid and Qualified Health Plan ("Exchange") populations. As a Risk Adjustment Analytics Manager, you will develop strategies to ensure risk adjustment data accuracy, coordinate the work of clinical and operations partners, and respond to new requirements from CMS or company leadership. You will prepare performance reporting and analyze the success of various risk adjustment strategies.
Essential Duties & Responsibilities
- Identify and close risk score gaps: Continually monitor member- and provider-facing activities to identify data inaccuracies or care gaps
- Develop, deliver, and performance manage provider insights for essential Risk-relevant initiatives related to HCC accuracy, recapture, and successful submission
- Develop and build operational reports to assist physicians in understanding their opportunities to improve documentation using internal EHR data & claims data from health plan payers
- Work with clinicians and operations partners to resolve issues and improve outcomes
- Use data to refine Risk Adjustment strategy: Assess our Risk Adjustment program by reviewing year-over-year risk condition persistence and the impact of supplemental activities. Modify and refine Risk Adjustment strategy based on your findings
- Serve as Subject Matter Expert: Work collaboratively with other departments to ensure Risk Adjustment goals are integrated into Cano operations
- Educate departments across the organization about how their activities impact risk adjustment and provide training of operational/clinical dashboards that support this work
- Prepare ongoing reporting: Utilize our Data Warehouse and work with analysts to conduct in-depth analysis of critical issues, including claims, enrollment and provider coding trends
- Ensure regulatory compliance: Continually review CMS or state guidance and regulations around Risk Adjustment, encounter submission and related topics. Update internal processes to ensure strict adherence to regulatory guidelines
Education & Experience
- Bachelor's degree required; Master's strongly preferred
- At least 5 years' experience working in health care, including at least 3 years working in Risk Adjustment at a Health Insurer, Provider Group or Risk Adjustment vendor
- Thorough understanding of Medicare insurance market and Risk Adjustment model, CMS-HCC (Medicare
- Experience modeling member-level risk score impacts of various activities
- Experience working with EHR data (ECW preferred)
- Experience working with clinicians regarding documentation strategies.
Education Requirements
Required/Preferred
Education Level
Discipline
Required
Bachelor's
Knowledge, Skills & Proficiencies
- Advanced analytical skills, including using SQL or other programming language to query large relational databases
- Experience in building Power BI reports
- Proactive communication style and ability to work with a variety of stakeholders to achieve project goals
Physical Requirements
This position works under usual office conditions. The associate is required to work at a personal computer as well as be on the phone for extended periods of time. Must be able to stand, sit, walk, and occasionally climb. The incumbent must be able to work extended and flexible hours and weekends as needed. Physical demands include ability to lift up to 50 lbs. The physical demands described here are representative of those that must be met by the associate to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Work Conditions
Must be able to perform essential functions such as typing, standing, sitting, stooping, and occasionally climbing
Travel Requirements
Travel Required
Amount of Expected Travel
Details
No
Tools & Equipment Used
Computer and peripherals, standard and customized software applications and tools, and usual office equipment
Disclaimer
The duties and responsibilities described above are designed to indicate the general nature and level of work performed by associates within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of associates assigned to this job. This is not an all-inclusive job description; therefore, management has the right to assign or reassign schedules, duties, and responsibilities to this job at any time. Cano Health is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.
Join our team that is making a difference!
Please see Cano Health's Notice of E-Verify Participation and the Right to Work post here