VNS Health

Overview

Performs data and analytical services in support of optimizing risk adjusted revenue, maintaining compliance with CMS standards and modeling financial impacts of changes in risk adjustment data and methodologies. Collaborates regularly with internal departments and external vendors on risk adjustment projects. Gathers, standardizes and consolidates financial claims, membership and premium data into data sets used for risk adjustment analytical and reporting needs. Leverages industry resources to increase knowledge and improve ROI of risk adjustment activities. Builds understanding of risk adjustment models in emerging business areas, including Medicaid. Works under general supervision.

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

What You Will Do

• Performs data and analytical services in support of optimizing risk adjusted revenue, maintaining compliance with CMS standards and modeling financial impacts of changes in risk adjustment data and methodologies.
• Collaborates regularly with internal departments, including Finance, Medicare Operations, Network Management, Provider Contracting, and Health Economics, and external vendors on risk adjustment projects. Calculates ROI for risk adjustment vendors, initiatives and projects.
• Gathers, standardizes and consolidates financial claims, membership and premium data into data sets that are used for risk adjustment analytical and reporting needs. Develops regular and ad hoc reports to supplement risk adjustment processes through query building and data extraction, including monthly risk adjustment revenue accruals.
• Leverages industry resources to increase knowledge and improve ROI of risk adjustment activities. Builds understanding of risk adjustment models in emerging business areas, including Medicaid.
• Maintains current knowledge of CMS’ Hierarchical Condition Categories (HCC) and Prescription Drug Risk Adjustment codes (RxHCCs) including risk adjustment values and formulas.
• Supports response to Risk Adjustment Data Validation (RADV) audits by preparing analytics.
• Leads risk adjustment analyses concerning complex issues and trends, coordinating with several different disciplines and staff. Assists in performing analyses used in the development of financial plans, re-forecasts, and other financial projections.
• Performs data mining functions and identifies trends in data. Informs Actuarial leadership of findings and collaborates to create predictive models using information obtained from mining, and to provide decision support.
• Works with the PMO and the product managers to provide insights into the current state of operations and identify gaps and opportunities for improvement.
• Works on identifying gaps in the claims, encounter reconciliation process, and provides insights to educate providers to improve billing practices.
• Builds reports and dashboards to track risk adjustment related projects and track the effectiveness of the initiatives.
• Participates in special projects and performs other duties as assigned.

Qualifications

Education:

Bachelor's Degree in Information Management, Statistics, Healthcare Informatics, Public Health or related field with equivalent knowledge requiredMaster's Degree in health related field or informatics preferred

Work Experience:

Minimum five years of increasingly responsible data analysis experience in a healthcare setting requiredPrior experience with Medicare Advantage Risk Adjustment preferredKnowledge of MLTC, Medicare Advantage and Medicaid preferredFamiliarity with medical claims and medical terminology preferredProficiency in personal computer programs including MS Excel (including formulas, sorts, filters, pivot tables, IF statements, VLOOKUP, HLOOKUP, etc.), Access (criteria statements, table links, and database and report creation), and Word requiredUnderstanding of basic principles and design of data warehousing requiredExperience with relational databases and programming experience in SQL or PL/SQL requiredProficiency conducting statistical analysis with R or Python requiredEffective oral, written and interpersonal communication skills requiredAbility to multi task in a fast-paced environment required

Pay Range

USD $98,200.00 - USD $130,800.00 /Yr.

About Us

VNS Health is one of the nation’s largest nonprofit home and community-based health care organizations. Innovating in health care for more than 130 years, our commitment to health and well-being is what drives us — we help people live, age and heal where they feel most comfortable, in their own homes, connected to their family and community. On any given day, more than 10,000 VNS Health team members deliver compassionate care, unparalleled expertise and 24/7 solutions and resources to the more than 43,000 “neighbors” who look to us for care. Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions and health plans designed to simplify the health care experience and meet the diverse and complex needs of the communities and people we serve in New York and beyond.