Manager, Data Reporting & Risk Adjustment

CommUnityCare in Tulsa, OK

  • Industry: Financial Services - Insurance - Actuary
  • Type: Full Time
position filled

JOB SUMMARY:

The Manager of Data Reporting is responsible for directing a team of data analysts in providing analytical support and various cost and quality metrics to both internal and external customers. Facilitates submission of encounter records to regulatory agencies, resolution of rejected records and reconciliations. Facilities submission of data for CMS and other regulatory audits. Oversees calculation and tracking of risk factors and analyzes trends in risk scores. Perform analysis and make recommendations for improving risk coding accuracy. Work with risk adjustment vendor and medical groups to improve risk coding accuracy and submission processes. Facilitate data warehouse maintenance using internal and external data source. Supervises and directs personnel in the preparation of various production and ad hoc reports.

KEY RESPONSIBILITIES:

  • Organize and lead the team responsible for risk score tracking and improvement.
  • Maintain internal risk adjustment models using published documentation from CMS.
  • Manage projects, including creating and leading a team of analysts, interaction with other departments and outside parties. Perform quality review of work product produced by assigned analysts.
  • Conduct major analytical projects without immediate supervision, including all aspects from programming to analyzing and abstracting information into written reports and possible oral presentation.
  • Oversee training of new analysts and professional development of supervised analysts.
  • Supervise and perform advanced analytical modeling for IPPS and OPPS pricers and other models as needed. Oversee provider contract modeling.
  • Facilitate submission of encounters to regulatory agencies (CMS Encounter Data and Edge Server Data).
  • Perform other duties as assigned.


QUALIFICATIONS:

  • Ability to conduct concurrently multiple analyses without immediate oversight.
  • Ability to manage multiple projects, including creating and leading a team of analysts, interaction with other departments and outside parties.
  • Ability to apply advanced actuarial, mathematical and statistical techniques and principles into the analysis of financial and health related data.
  • Possess strong oral and written communication skills.
  • Successful completion of Health Care Sanctions background check.
  • Proficient in Microsoft Office applications.

EDUCATION/EXPERIENCE:

  • Bachelor degree in Mathematics, Statistics, Economics, Actuarial Science or other quantative discipline required. Master degree a plus.
  • Proficiency in SAS and other Analytical Software
  • 6 plus years analytical experience; preferably in a Managed Care environment.
  • 4-6 years management experience required.
  • Experience with various risk adjustment models including the CMS Medicare model, CMS ACA Model and 3rd party software strongly preferred.

Associated topics: actuarial assistant, actuary consultant, analyst, assistant actuary, associate actuary, cost, model, probability, retirement actuary, risk

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