This role is responsible for the analysis, preparation, and presentation of outcomes using healthcare claims, pharmacy, membership, and/or revenue data. The role is responsible for the activity surrounding submission of Risk Adjustment (RA) data to CMS, Risk Adjustment Data Validation (RADV) audit responses, and the calculation of revenue impact of submitted data and medical information. Frequently work with Finance to prepare department budgets and Provider Relations to calculate provider bonuses.
Responsible for all activities related to the administration of data / databases, analyzing trends, or reconciling data. Combines complex IT capabilities with advanced clinical knowledge to determine trends, cost/benefit ratios, and forecasting of health care costs, medical management, and health economics.
This position requires a high level of expertise in both analyzing medical data and information systems. Typically requires Bachelors in Statistics, Mathematics, Epidemiology or equivalent training and mastery; 5-7 years experience in related health care analytics.
- Designs, develops, and implements the tools, standards, models, and methodology for analyzing data.
Partners with other departments in the organization and leadership teams to identify requirements, establish priorities, and ensure accuracy of data submitted.
Consults with and advises users of various databases.
Combines complex IT capabilities with advanced clinical knowledge to determine trends, cost/benefit ratios, and forecasting of health care costs, medical management, and health economics.
May also be responsible for designing and implementing the systems and programming to analyze and report findings.
Responsible for research using multiple sources of data and analyzing algorithms to determine health care expenditures and utilization patterns.
May provide guidance or expertise to less experienced analysts.
CIGNA - 19 months ago
With a significant position in the US health insurance market, CIGNA covers some 11.5 million Americans with its various medical plans. The...