Risk Adjustment Analytics Manager in Long Beach, CA at DISYS

Date Posted: 4/24/2018

Job Snapshot

Job Description

Title: Manager, Risk Adjustment Analytics

Location: Long Beach, CA

Duration: 6 month contract-to-hire

Compensation: $55 to $65W2 for contract, $95k to $105k conversion salary, DOE

DISYS is seeking an Analytics Manager with a background in SQL, SSRS, SSIS Data Analysis, and a deep understanding of risk adjustment data for Medicare, MMP and Marketplace.

This is a 6 month contract to hire, 50:50 technical to people management, with a greater focus on domain knowledge than technical skill.

The Manager, Risk Adjustment Analytics is responsible for the timely and accurate collection, flow and processing of data for risk adjustment, including Medicare, MMP and Marketplace.  The Manager will establish, monitor, and maintain the processes, IT systems and servicers that collect and process the data from claims, encounters, electronic medical records, medical record coding, Health Evaluation Program Assessments, and in home assessments.  Reporting and maintaining SOX compliance is also a responsibility of this position.  The Manager will work collaboratively with the Director of Risk Adjustment Programs, Manager of Risk Adjustment Operations, and Manager of Risk Adjustment Data Validation in the delivery of overall department goals and objectives. 

Knowledge of Risk Adjustment Process Systems (RAPS) as well as 837I (5010) formats and protocols required.

Responsibilities:

  • Manages RA Analysts, Sr. Analysts, Contractors, and Program Managers
  • Implements coaching and training plans
  • Sets and mitigates RA Data and Analytics policies and procedures
  • Negotiates and maintains vendor contracts and relationships as needed
  • Monitors vendor progress and performance
  • Escalate gaps in projects to Director or senior leadership
  • Manage monthly extracts from Enterprise Reporting Repository (ERR) and the loading of claims and encounter records into risk adjustment CDM application.  Resolve any processing issues on a timely basis.  Coordinate with Corporate Operations to ensure completeness and accuracy of claims and encounter records.
  • Direct, oversee, and report the claims and encounter submissions per the SOX compliance process
  • Create Risk Adjustment Processing System (RAPS) file submissions and work with Trizetto to arrange submission to CMS
  • Manage the submission of edata through CDM to CMS from providers’ supplemental data files, in home assessment records, medical record review coding files, and health evaluation program coding.
  • Track and process RAPS return files from CMS
  • Track, analyze and fix errors and rejections that occur in the CDM application and that are returned from CMS.
  • Perform as the Risk Adjustment department liaison and point of contact with Trizetto and MHI IT on the CDM application.  Design and conduct testing of application changes and updgrades.
  • Manage the Electronic Data Processing (EDPS) data submission process and ensure that all available data is accepted by CMS and manage the transition from RAPS to EDPS.   Own and maintain the Edge server, and ensure data is valid and complete.
  • Coordinate with IT on ICD-10 conversion and ensure risk adjustment needs are met
  • Map and manage all the medical charts received by RAMP team including HEP, IHA, HEDIS
  • Establish PMPY claims/encounters dashboards and alert local teams when volumes do not meet expectations
  • Develop Marketplace HHS default Risk Score calculation model in SQL server and maintain.
  • Manage welcome call data, lab and Rx data and use it for the potential riskscore for Marketplace members

Experience:

  • Bachelor's Degree and/or a professional certification requiring formal education beyond a two-year college or equivalent experience in information technology or data processing
  • MHA or MBA preferred
  • 3+ years’ experience in routine medical claims and encounter processing preferably in Medicare risk adjustment
  • One to two years of management experience including people management
  • Experience with the requirements of SOX and Risk Adjustment Data Validation.
  • Experience working in a multiple state health plan environment.
  • 3-6 years’ increasingly complex database and data management responsibilities working with SQL Server
  • 3-6 years’ experience in quantifying, measuring, and analyzing performance management/financial metrics
  • Knowledge of regulations related to data submission for Medicare Advantage, MMP, and Marketplace risk adjustment
  • Knowledge of RAPS and 837I (5010) formats and file protocols
  • Ability to interact effectively with manager and director level employees
  • Strong leadership capabilities, and ability to initiate and maintain cross-team relationships

Preferred Experience:

  • Experience with Trizetto QNXT and CDM application
  • Specific experience in RAPS and EDPS data management and submission

Job Requirements

SQL, SSIS, SSRS, SOX, Risk Adjustment Medicaid/MMP/Marketplace, 837I (5010)

Digital Intelligence Systems, LLC. is an Equal Opportunity Employer, M/F/D/V. We do not discriminate against any employee or applicant because they inquired about, discussed, or disclosed compensation. Email recruitinghelp @ disys.com to contact us if you are an individual with a disability and require accommodation in the application process.Digital Intelligence Systems, LLC. is an Equal Opportunity Employer, M/F/D/V. We do not discriminate against any employee or applicant because they inquired about, discussed, or disclosed compensation. Email recruitinghelp @ disys.com to contact us if you are an individual with a disability and require accommodation in the application process.