Expert Risk Adjustment Data Analyst - Remote (Baltimore, MD)

| Baltimore, MD
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Welcome to Allscripts! Our Mission is to be the most trusted provider of innovative solutions that empower all stakeholders across the healthcare continuum to deliver world-class outcomes. Our Vision is a Connected Community of Health that spans continents and borders. With the largest community of clients in healthcare, Allscripts is able to deliver an integrated platform of clinical, financial, connectivity and information solutions to facilitate enhanced collaboration and exchange of critical patient information.

About Pulse8, Inc.

Pulse8 is an innovative Healthcare Analytics and Technology Company that delivers visibility and transparency for Risk Adjustment and Quality Management programs. We enable health plans and at-risk providers to achieve the greatest financial impact in the Health Insurance Exchange (HIX), Medicare Advantage, and Medicaid markets. By combining advanced analytic methodologies with extensive health plan experience, Pulse8 has developed a suite of uniquely pragmatic solutions that are revolutionizing risk adjustment. Pulse8's flexible business intelligence tools offer real-time visibility into member and provider activities so our clients can apply the most cost-effective and appropriate interventions for closing gaps in documentation, coding, and quality.

What's cool about working for Pulse8?We're a close-knit team of Healthcare and Technology experts dedicated to helping people live longer, healthier lives. You'll get to help us design and build innovative solutions from the ground up and have the opportunity to do lots of interesting things in an entrepreneurial culture. We offer competitive benefits and much, much more!

Position Description

The Expert Risk Adjustment Analyst will assist our organization as a subject-matter-expert in Medicare Advantage, Affordable Care Act (ACA) and/or Medicaid Risk Adjustment by leading business cases for algorithm development and improvement, creating customer financial calculations and projections, researching customer queries of analytics performance, and creating requirements for new analytics and data products.

This is a remote role.

Responsibilities
  • Developing business cases and requirements for new products and current product enhancements.
  • Leading customer requests for ad hoc reporting or research.
  • Owning customer financial improvement modeling and engaging directly with current or new customers to update models.
  • Leading research initiatives to monitor Pulse8's algorithm performance over time and recommend future enhancements.
  • Collaborate with Pulse8 clinicians in outcomes, algorithm performance, and new product development.
  • Develop customer presentations and reporting enhancements to streamline Pulse8 operations and support processes.
  • Providing training and guidance to customers and other teams on all facets of the Risk Adjustment process, from initial data capture at point-of-care, through acceptance to CMS, and successfully validated through audit.
  • Researching government regulatory guidance, providing expert interpretation for impacts to Pulse8 products and customers


Qualifications

Academic and professional qualifications:
  • Bachelor's degree in Actuarial Science, Math, Statistics, or in a related field of study
  • 6 to 8 years of experience analyzing and interpreting MA/ACA Risk Adjustment data
  • Experience supporting the development of scalable analytic and reporting solutions


Experience:

Minimum Essential Knowledge / Skills:
  • Extensive experience in healthcare industry, with a focus on Risk Adjustment
  • Experience with MA/ACA Risk Scoring methodology, including familiarity with condition categories (HCC)
  • Experience with actuarial or financial modeling concepts
  • Experience interacting with large amounts of healthcare data; directly with the following CMS files (MMR, MOR, MAO-004, MAO-002, EDGE RARSD, EDGE RATEE)
  • Experience working with clinical classification such as diagnoses (ICD), procedures (HCPCS, CPT) and claims processing
  • Experience working with data to and from submission systems (RAPS, EDPS, Edge), including background on filtering logic for each system
  • Experience with MA mid-year and final year projections (MYRA, FYRA) and/or ACA transfer payments
  • Advance knowledge of SAS and experience with SQL
  • Working knowledge of statistics with ability/interest to become proficient
  • Proven technical, analytical, detail oriented, and problem solving
  • Strong written and verbal communication
  • Professional and interpersonal
  • Self-initiative and leadership
  • Ability to work within a team environment
  • Ability to interface with both external and internal personnel at all levels.


Desired Skills:
  • Experience with Tableau, Sisense or similar Business Intelligence tools


Travel requirements:
  • All Pulse8 employees attend two company summits per year in various locations.


Working Arrangements:
  • Monday through Friday or as defined by assignment requirements
  • This is a remote/virtual position


#LI-ALL

Pulse8 is a stand-alone brand, fully owned by Allscripts, with its own C-level and senior leadership. When you work for Pulse8, you get the advantages and benefits of working with a large, public company with the innovative culture and direction and of a small, nimble company.

Must have received or be willing to receive the COVID-19 vaccine by date of hire to be considered for employment with Allscripts.

Visa Sponsorship is not offered for this position.

At Allscripts, our greatest strength comes from bringing together talented people with diverse perspectives to support the technology needs of 180,000 physicians, 1,500 hospitals and 10,000 postacute organizations across the globe. Allscripts offers a comprehensive compensation and benefits package, including holidays, vacation, medical, dental, and vision insurance, company paid life insurance and retirement savings.

Allscripts' policy is to provide equal employment opportunity and affirmative action in all of its employment practices without regard to race, color, religion, sex, national origin, ancestry, marital status, protected veteran status, age, individuals with disabilities, sexual orientation or gender identity or expression or any other legally protected category. Applicants for North American based positions with Allscripts must be legally authorized to work in the United States or Canada. Verification of employment eligibility will be required as a condition of hire. Allscripts is proud to be an equal opportunity workplace dedicated to pursing and hiring a diverse and inclusive workforce.

From a "VEVRAA Federal Contractor" We request Priority Referral of Protected Veterans

This is an official Allscripts Job posting. To avoid identity theft, please only consider applying to jobs posted on our official corporate site.

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More Information on Allscripts
Allscripts operates in the Software industry. The company is located in Chicago, IL, Raleigh, NC and Alpharetta, GA. Allscripts was founded in 1986. It has 8224 total employees. It offers perks and benefits such as Flexible Spending Account (FSA), Disability Insurance, Dental Benefits, Vision Benefits, Health Insurance Benefits and Life Insurance. To see all 468 open jobs at Allscripts, click here.
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