Director Government Markets Risk Adjustment Analytics
The Director of Risk Adjustment Analytics reports to the Vice President, Government Markets Performance and is responsible for analytics and reporting related to both Medicare and ACA risk adjustment. The Director will interact collaboratively with the Medicare Stars team, as well as the Risk Adjustment Data Operations, and Risk Adjustment Supplemental Programs teams. Other stakeholders include Finance, Actuary, and Informatics.
Responsibilities:
· Leads the teams by coaching and supporting the team members in their individual success, setting department goals and strategy, and helping team members understand and meet requirements.
· Develops and evaluates Medicare Advantage and ACA Risk Adjustment accuracy improvement strategy. Includes constantly identifying initiatives that yield improvement and/or optimization.
· Generates insights that impact both long term strategy and shorter-term tactical decision making.
· Directs the teams responsible to calculate valuation of supplemental programs to inform supplemental program strategy.
· Oversees forecast of risk scores for financial planning, actuarial pricing, and overall segment strategy
· Directs the teams responsible to calculate risk scores on a periodic basis to inform supplemental programs performance and actuarial forecasting.
· Maintains a data environment that has appropriate controls, audit tracking, and is efficient and available for multiple self-service users
· Collaborates with leadership in Information Technology, Informatics and Facilitated Health Networks to build and maintain effective relationships to meet the goals and objectives of Government Markets. Specifically, help commission, specify, and apply technology capabilities to core Medicare Advantage and ACA activities.
· Develops analytics to effectively evaluate provider performance encompassing Risk Adjustment. Manages process to ensure results are updated regularly and published in dashboards widely available across organization.
· Collaborates with appropriate business areas to understand trends driving member and provider behavior.
Qualifications:
· Bachelor’s Degree in Business, Healthcare Administration, Finance, Economics, equivalent discipline, or related work experience. MBA/MS/MA preferred.
· Ten (10) or more years of progressively more responsible experience with Government Programs including Medicare Advantage Risk Adjustment and/or ACA Risk Adjustment.
· Demonstrated ability to lead teams in delivering high quality analytics work
· Excellent knowledge of Medicare Advantage and/or the ACA Risk marketplace and understanding of CMS initiatives and reasoning.
· Related strategic operations experience and development in the health care & insurance business segment.
· Strong knowledge and experience in compliance with CMS regulatory guidance.
· Demonstrated ability to work collaboratively in team environment
· Strong communication skills to interact with stakeholders both inside and outside the company.
· Excellent analytical, interpersonal and presentation skills.
· Expert level knowledge of SQL Server, SSIS, SSRS
· Expert level knowledge of MS Access, Excel, PowerPoint, and MS Project
· Strong knowledge of Tableau data visualization software
· Knowledge of statistical software (R or SAS)
A signed Non-Compete is Required for this role
A signed Non-Compete is Required for this role
IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
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Inclusion and Belonging
At IBX, everyone can feel valued, supported, and comfortable to be themselves, and all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. Celebrating and embracing diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
About Our Company
Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.
At Independence, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations. For more information about Independence access our website at www.ibx.com. We’re revolutionizing health care, and our focus is on you!
Equal Employment Opportunity
IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Agency Disclaimer
All resumes submitted directly to an Independence Blue Cross employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of Independence Blue Cross and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by Independence Blue Cross or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.