- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
- Volunteer Time Off (VTO)
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Enterprise Risk Adjustment Analyst III - Los Angeles, United States - L.A. Care Health Plan
Description
Salary Range: $88, Min.) - $115, Mid.) - $142, Max.)
Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.
Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
Job Summary
The Enterprise Risk Adjustment Analyst III will provide a key leadership role in the Risk Adjustment Department by independently determine and recommend the source/type of data to be used, design/method in which to create reports or conduct analysis to address business objectives, and recommendations for course of action.
This position will work in collaboration with the Enterprise Risk Adjustment department leadership and provide leadership/guidance in matters related to data processing, data storage, and data architecture. The position will provide guidance and direction to the analyst, internal and external stakeholders with regards to reporting and analytics.
Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.
Duties
Serve as Subject Matter Expert (SME) for the data processing, reporting, and analytics required to support the Risk Adjustment department operations. Chief Architect for reporting and analytics in support of Risk Adjustment operations for multiple lines of businesses. Serves as key contact for both internal (L.A. Care) and external (Vendors, regulatory agencies, etc.) requestors for Risk Adjustment data and reporting. Work with the risk adjustment vendors and keeps up to date on the latest risk adjustment changes that regulatory bodies pass on to health plans as it relates to reimbursement reporting requirements. Brings identified concerns to Manager with recommendations for resolution.
Applies subject expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the project's/program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.
Create and produce summary reporting artifacts to give the Risk Adjustment Department the ability to monitor its performance. Provide guidance and direction to the analyst, internal and external stakeholders with regards to reporting and analytics. Conduct and provide analytical insight to gaps in performance.
Continuously monitor and review the daily operations to identify areas of improvement and for automation process. Designs and creates processes for data extraction, summaries, and higher level analytic functions to create and use on data queries and stored procedures. Creates and maintains database for the Risk Adjustment team to improve the workflow in various operational areas of risk adjustment.
Understand the end to end requirements for XML and 837 data processing channels to provide impact analyses from regulatory changes to these processes, and data reconciliation gaps.
Perform other duties as assigned.
Duties Continued
Education Required
Bachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.
Education Preferred
Experience
Required:
At least 5 years of experience working in a risk adjustment role with increasing responsibilities and working with data submitted to regulatory agencies, and the return reports received from same.
Skills
Required:
Ability to consult with senior management help define business objectives and recommend analysis approach to address these objectives.
Ability to provide expertise on analytic, programmatic, and process changes that is a response to changing business needs.
Ability to query from various internal databases and external vendors systems in order to write/build/develop needed data to perform higher level of analytics to address business objectives. Provide recommendations to senior leadership based on analytics outcome.
Knowledge of risk adjustment processes for multiple lines of business.
Reporting and analytics experience of SQL Server, Visual Studio 2012, Oracle, Microsoft Access and Excel.
Knowledge of MS Word, Adobe Reader, PowerPoint programs.
Licenses/Certifications Required
Licenses/Certifications Preferred
Required Training
Physical Requirements
Light
Additional Information
Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
L.A. Care offers a wide range of benefits including
