Risk Adjustment Analytics Manager
VirtualVocationsToledo, Ohio, United States2 days ago
Job type
- Full-time
Job description
A company is looking for a Sr Manager, Risk Adjustment Analytics.
Key Responsibilities
Lead financial and strategic aspects of CMS risk adjustment to provide actionable insights for executive decision-making
Create and maintain leadership reports on revenue financials and the impact of initiatives on Medical Loss Ratio (MLR)
Develop SQL queries against clinical operations and medical claims data to support analytics and stakeholder insights
Required Qualifications, Training, and Education
Bachelor's or Master's Degree preferred
Expert knowledge of CMS-HCC models V24 and V28
Understanding of claims data lifecycle and submission systems
Knowledge of regulations, compliance, and audits related to risk adjustment
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Manager Adjustment • Toledo, Ohio, United States
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