Resp & Qualifications

PURPOSE:

Supports Risk Adjustment & Stars organization to optimize Risk Adjustment revenue and coding accuracy through data-driven approach to closing gaps and risks in coding and care delivery across Medicare & Medicaid populations. Responsible for developing performance monitoring reports and analytics related to Risk Adjustment & Stars programs and processes. We are looking for an experienced professional to work remotely from within the greater Baltimore metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities.

ESSENTIAL FUNCTIONS:

• Develops and works with structured data from multiple sources such as HEDIS, CAHPS, Stars and Risk Adjustment related performance and benchmark data. Interprets data, analyzes results using statistical techniques, and provides ongoing reports.

• Designs, manages, and conducts review of Risk Adjustment & Stars program data sets using data from multiple systems. Produces regular and adhoc report for business stakeholders to monitor and track Risk Adjustment and Stars performance metrics and enable Risk Adjustment optimization.

• Uses business intelligence, statistical, and/or data science techniques to analyze data to evaluate the efficacy of Risk Adjustment & Stars activities (HEDIS, CAHPS, Health Outcomes Survey, Operation & Accurate Risk Optimization initiatives).

• Collaborates with third party vendors and internal stakeholders including Stars/Quality, Finance and Actuarial areas to optimize Risk Adjustment performance, accurate coding and drive overall quality of care.

• Establishes standards with IT and Data Services teams. Represents the Stars/Risk Adjustment team during enterprise prioritization sessions.

QUALIFICATIONS:

Education Level: Bachelor's Degree, Data Science, Mathematics, Computer Science, Statistics, Business or related field OR in lieu of a bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Experience: 5 years' experience in Risk Adjustment/Quality/Stars departments with a data visualization and performance monitoring role.

Knowledge, Skills and Abilities (KSAs)

• Strong Risk Adjustment & Stars knowledge.

• Strong quantitative and qualitative skills.

• Knowledge and understanding of analytical & data visualization tools, such as Power BI, SAS, Excel, SQL.

• Excellent communication skills both written and verbal.

• Ability to learn quickly and take direction.

• Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging. Salary Range: $79,416 - $157,729

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

Risk Adjustment

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship.

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REQNUMBER: 19690