Health Care Analyst II (Risk Adjustment Analytics)

** Health Care Analyst II (Risk Adjustment Analytics)**

**Job Category****:** Healthcare Informatics **Requisition Number****:** HEALT004083 Showing 1 location **Job Details**

**Description**

**Health Care Analyst II (Risk Adjustment Analytics)**

* Long Beach, CA

* Full-time

**About SCAN**

As one of the nations largest not-for-profit Medicare Advantage plans, serving more than 200,000 members in California, SCAN Health Plan has been a mission-driven organization dedicated to keeping seniors healthy and independent for over 40 years. SCAN employees are passionate about what they do, and understand that success is based on achieving the mission. Employees are afforded with the training and tools necessary to do their jobs and are rewarded for their efforts and recognized as experts in their fields. To learn more, visit or follow us on social media: *; ;* and *.*

**The Opportunity**

Works under general supervision to support multiple aspects of Medicare Risk Adjustment, including data acquisition, quality review, submission to CMS and maintaining effective forecasting for both the clinical and financial impact of these data. This role will support Health Care Informatics initiatives by collecting and analyzing health care related data, performing data management, quality improvement studies, conducting statistical analysis, generating reports, and providing data based recommendations to the organizations decision makers.

**You Will**

* Responsible for research and moderate analysis of Medicare Advantage and healthcare data specific to membership, provider, claims, authorizations, pharmacy, and financial information.

* Conduct data management, quality improvement studies, statistical analysis, and report generation. Present findings to higher level Analysts as well as HCI mid and senior management.

* Perform moderate to complex analysis and interprets organizational data, including but not limited to data mining, data verification, mapping, scrubbing, and scrapping.

* Deliver actionable, supportable findings within tight deadlines and changing requirements.

* Develop and deliver actionable and supportable findings within tight deadlines and changing requirements.

* Conduct investigative research to uncover root causes, interpret results, identify trends, and make recommendations for action.

* Monitor and improve RAPS and EDPS error rates, support timely encounter data submission.

* Ensure compliance with CMS data submissions by creating and recommending appropriate data QA and HCC/RAF workflow processes. Work with the Encounter data team to resolve issues and make recommendations for improvement of processes.

* Work directly with internal and external stakeholders to troubleshoot and correct data anomalies.

* Manage multiple moderate to complex projects concurrently. Complete them accurately within a limited time table by effectively prioritizing work and communicating workload issues to management.

* Support customer needs for what-if scenario analysis by developing analytical tools/models.

Conduct informal training, provide guidance, and supports lower level Analysts.

* Serve as a point of contact for internal and external customers and resolves both routine and more complex questions and problems. Escalate only the most complex issues to higher levels as needed.

* Ensure understanding of business needs by proactively monitoring and clarifying the technical responses to business requirements on all Medicare related projects.

* Assist with the development of the risk score forecast and reconciliation process to support the organization's budget and accrual process.

* Maintain professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; and participating in professional societies.

* Contribute to team effort by accomplishing related results as needed.

* Actively supports the achievement of SCANs Vision and Goals

* Other duties as assigned.

**Requirements**

**Your Qualifications**

* Bachelor's Degree, or equivalent work experience required**.**

* 3+ years of analytical experience, or 3+ years of analytical experience in a Healthcare/Managed Care environment required.

* Experience with CMS-HCC based Risk Model, Payment Cycle and Risk Score Calculation is preferred.

* Experience in risk score projection, forecasting and reconciliation is preferred.

* Experience in supporting and evaluating prospective, retrospective and audit programs is preferred.

* Experience with medical claims / encounters data is preferred.

* Ability to effectively interact with, and present findings to customers at all levels of the organization including operational managers, medical directors and executives required.

Advanced skills in:

* MS Office required

* MS ACCESS including strong knowledge base of VBA preferred

* MS SQL Server (Strong command over SQL- DDL, DML, TCL, and DCL) required

* SQL Server Reporting Services and SQL Server Integration Services experience preferred.

* SAS (Statistical Analysis System) experience preferred.

* Tableau BI tool experience preferred.

**Covid-19 Vaccination Policy**

To ensure a healthy and safe work environment, all SCAN employees will be required to be fully vaccinated by January 1, 2022. Generally, you are considered fully vaccinated 14 days after receiving the last dose, as recommended by the manufacturer, of a vaccine that has been authorized by the FDA for use in the United States, including vaccinations that have been approved pursuant to an Emergency Use Authorization. If fully vaccinated outside of the United States, the vaccination must be listed for emergency use by the World Health Organization (WHO). If you cannot receive the vaccine because of a disability/medical reason or sincerely-held religious belief, you may request an accommodation to this requirement by contacting

* A competitive compensation and benefits program

* An annual employee bonus program

* Robust Wellness Program

* Generous paid-time-off (PTO)

* Ten paid holidays per year, plus 1 additional floating holiday

* Excellent 403(b) Retirement Saving Plan with employer match

* Robust employee recognition program

* Tuition reimbursement

* A work-life balance

* An opportunity to become part of a team that makes a difference to our members and our community every day!

We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!

At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.

SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential