Medicare Risk Adjustment Analyst
Remote Opportunity
Reveleer is a healthcare data and analytics company that uses Artificial Intelligence to give health plans across all business lines greater control over their Quality Improvement, Risk Adjustment, and Member Management programs. With one transformative solution, the Reveleer platform enables plans to independently execute and manage every aspect of enrollment, provider outreach and data retrieval, coding, abstraction, reporting, and submissions. Leveraging proprietary technology, robust data sets, and subject matter expertise, Reveleer provides complete record retrieval and review services so health plans can confidently plan and execute risk, quality, and member management programs to deliver more value and improved outcomes.
What You'll Do with Risk Adjustment Data:
- Ideate and build data pipelines that facilitate process improvement and ROI analytics for Reveleer risk adjustment products.
- In a SQL and Python environment, develop risk adjustment models to calculate RAF scores, generate financial projections and identify opportunities.
- Wrangle large data sets from health plans, CMS and internal Reveleer processes. Develop scalable solutions to ingest, synthesize and utilize these data sets to solve business problems.
- Serve as the subject matter expert for multiple areas of risk adjustment, health plan data structures and medical record review operations.
- Collaborate with product managers, data scientists and data engineers, in an Agile and technology-driven environment.
- Present in front of internal and external stakeholders. Support sales and operations teams.
Requirements:
- Demonstrated ability to process complex data sets in a SQL/SAS environment to generate actionable insights.
- Experience with healthcare data. Preferably health plan claims, membership and risk adjustment data.
- Strong analytical skills and critical thinking. Intellectual curiosity and flexibility. Ability to independently break down complex problems into discrete, solvable pieces.
- Desire to take ownership of complex projects and the responsibility of guiding those projects from ideation through completion.
- Demonstrated ability to build trust with business stakeholders, manage the relationship and socialize insights effectively.
- Be able to communicate analytical insights with a variety of business stakeholders across different technical levels (including senior leaders)
- Self-motivated and be able to work independently.
Nice to have:
- At least 3 years of work experience in Risk Adjustment analytics, preferable for multiple lines of business.
- Experience with data visualization software (e.g., Looker, Tableau, Power BI)
- Actuarial background
- Demonstrated experience with data science techniques and development of predictive models.
- Experience with NLP methods.
- Experience in a healthcare environment.
- Experience of processing JSON files
- Experience of cloud (AWS preferred)
What You’ll Receive:
- Competitive pay
- Medical, Dental and Vision benefits including HSA/FSA
- 401k with Employer Match
- 100% paid short term and long-term disability insurance
- PTO plan and 10 paid company holidays
Salary Range: $90,000 - $140,000 / annually
Our compensation reflects the cost of labor across several US geographic markets. Pay is based on several factors including market location and may vary depending on job-related knowledge, skills, and experience.
Reveleer E-Verifies all new hires.
Reveleer is an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, gender identity, sexual orientation, age, marital status, veteran status, disability status or genetic information, in compliance with applicable federal, state and local law.