Data Scientist III - Risk Adjustment Compliance

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
 

Position Purpose:
Executes Line 2 oversight of Risk Adjustment including monitoring, auditing, and Line 1 oversight. Identifies and evaluates risk levels and effectively communicates findings to stakeholders, ensuring the highest quality of risk adjustment data. Develop algorithms and models to identify high risk areas and potential non-compliance.

• Develop models to detect coding anomalies and identify high-risk areas.
• Create analytical tools to assess the quality of Risk Adjustment data.
• Build oversight models to evaluate program effectiveness.
• Conduct exploratory data analysis to support CMS and OIG compliance.
• Monitor quality metrics and identify opportunities for improvement.
• Apply statistical models to detect coding patterns and relevant events.
• Present findings to Risk Adjustment, Legal, Compliance, and executive teams.
• Automate processes to scale analysis and detect high-risk areas.
• Validate program outcomes using data analysis, statistical modeling and reporting tools such as Statistical Analysis System (SAS) and R programing language.
• Manage multiple projects and assist in training Data Analysts.
• Collaborate with technical teams for development and implementation.
• Advise Line 1 teams on systemic controls to prevent non-compliance.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience:
Bachelor's Degree in Data Science, Statistics, Information Systems, Health Informatics or related field or equivalent experience required
5+ years Statistical Analysis, or required
3+ years Related IT experience, including data warehouse, coding or ETL required

Medicare Risk Adjustment experience preferred

Project Management or Project Implementation required
ICD-10, HCC, and other Risk Adjustment related data sets preferred
Risk Adjustment and Encounter experience preferred
Licenses/Certifications:
CHDA (Certified Health Data Analyst) preferred
 

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act