Senior Analyst, Risk Adjustment and ACO Analytics

  • Somerville, MA


: $110,070.00 - $166,700.00 /year *

Employment Type

: Full-Time


: Financial Services - Insurance

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As a not-for-profit organization, Partners HealthCare is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Women's Hospital and Massachusetts General Hospital, Partners HealthCare supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care and other health-related entities. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research.. We're focused on a people-first culture for our system's patients and our professional family. That's why we provide our employees with more ways to achieve their potential. Partners HealthCare is committed to aligning our employees' personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal development--and we recognize success at every step.. Our employees use the Partners HealthCare values to govern decisions, actions and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration.. Position Overview. The Enterprise Analytics department within Partners Data and Analytics Organization (DAO) is seeking a skilled analyst to be the point person on risk adjustment analytics and be part of a team focusing on analyzing cost and utilization trends for Partners Accountable Care Organization. The Senior Analyst will demonstrate in-depth understanding of various risk adjustment models and other healthcare data to extract, analyze, interpret, and communicate healthcare trends, disease prevalence, comorbidities and medical utilization. The Senior Analyst will also take on analytical responsibilities in external risk contracts, Internal Performance Framework (IPF) program and Population Heath Management programmatic initiatives.. Responsible for report prototyping and analytics supporting risk adjustment program operations.. Develop algorithm leveraging EMR and claims data to inform risk recapture programs and identify areas for improvement on efficiency and care coordination.. Serve as a subject matter expert (SME) on risk adjustment methodology and models. Educate stakeholders on how various risk models function to better inform process improvement opportunities.. Design, develop and maintain risk adjustment reporting solutions that measure risk scores, monitor suspect conditions, model performance, and identify areas of improvement.. Contribute to the design and implementation of advanced analytical tools (e.g., NLP and machine learning) for business intelligence.. Work with the Enterprise Data Warehouse and Business Intelligence Services team to develop standards around the use of risk adjustment data, develop new reporting initiatives, and improve existing tools.. Analyze medical expense trends and trend drivers for the managed care population and produce actional insights to help leadership formulating strategies to improve care and contain costs.. Other duties as assigned.. Qualifications. Bachelor's degree required. Master's degree in Public Health, Biostatistics, Actuarial Science, Economics, Epidemiology, or related fields preferred.. At least 4 years of full-time hands-on experience in data analytics required.. A combination of education and experience may be substituted for requirements.. Skills Required. Experience with clinical and medical claims data and disease diagnostic coding practice a plus.. In-depth knowledge/experience of various risk adjustment models such as CMS-HCC, HHS-HCC, ACG, and DxCG strongly preferred.. Experience with applying natural language processing (NLP) algorithms preferred.. Advanced skills in SAS required.. Proficiency in SQL, R, Python, or Tableau strongly preferred.. Strong understanding of data structure/integration and relational database design. Ability to manage multiple projects simultaneously, set priorities, and collaborate with team members and others throughout the organization.. Ability to work with multiple stakeholders with competing priorities.. Self-motivated, resourceful, and able to take initiative.. Confident working independently.. Able to quickly adapt and learn in an ever-changing technical, contractual, and regulatory environment.. Working Conditions. Standard office environment with possible local travel to Partners sites. EEO Statement. Partners HealthCare is an Equal Opportunity Employer & by embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law.. Primary Location: MA-Somerville-Assembly Row - PHS. Work Locations: Assembly Row - PHS 399 Revolution Drive Somerville 02145. As a not-for-profit organization, Partners HealthCare is committed to supporting patient care, research, teaching, and service to the com...
Associated topics: actuarial assistant, actuary consultant, associate actuary, director actuary, investment actuary, mathmatics, model, retirement actuary, risk, statistics

* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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