Supervisor, Risk Adjustment Data and Analytics
Advantasure

Job Info

SUMMARY:

The Supervisor is responsible for planning, organizing, directing, implementation, and leading department assignments. This position is accountable for architecting and designing comprehensive data-driven solutions that meet client's requirements and incrementally move assigned subject areas to the appropriate future state. The ideal individual will be responsible for successful design, architecture and overall accountability for technical and business projects in the Risk adjustment space as it relates to risk adjustment, EDPS/RAPS reconciliation and revenue implications across the MA, ACA and Medicaid lines of business which ensures risk-adjusted revenue is optimized and appropriate. This position will serve as a subject matter expert for both internal and external stakeholders across the enterprise.

In addition to the duties listed above, the manager will assign personnel to various projects and direct their activities. They review, evaluate work and prepares performance reports; confers with and advises subordinates on policies, procedures, technical problems, priorities, and methods; consults with personnel in other information systems sections to coordinate activities; prepares activity and progress reports. This position operates within broad objectives to ensure optimum utilization of resources and budget while ensuring key performance metrics and business objectives are defined, achieved, and provide ongoing comprehensive status of current and projected performance

RESPONSIBILITIES/TASKS:

• Responsible for providing strong technical leadership required to analyze key business drivers and strategy to create current state and future state solutions focusing on data modeling and integration but also encompassing data definition, data standardization, data mastering, data governance, and proposed architectural changes by working with technical teams.

• Provide technical direction and leadership to proactively upgrade and align solutions with evolving technologies and business needs, including implementation strategies, focusing on solution optimization and stability. This includes proactively providing business overviews, system testing, user testing, validation documentation and data expertise for medium to highly complex projects and requests as well as creating and maintaining data-centric solutions including third party program integrations.

• Proactively identify data integrity issues, system and programming problems, and develop strategies and implement improvement solutions.

• Oversee proofs of concepts for new reporting, processes, and/or workflows. Implements solutions according to requirements, specifications, and compliance/regulatory standards.

• Actively pursue continuing education and networking opportunities to maintain thorough knowledge of evolving best practices within the industry; this includes providing expertise with respect to other health plans and what is happening in the industry in risk adjustment

• Manages and monitors multiple projects simultaneously by establishing project plans and objectives to ensure goal attainment within defined parameters.

• Develops lines of communication to discuss/review results of an analysis to management via reports/presentations and assists management in implementing programs that provide solutions.

• Investigates, reviews, recommends, communicates, and implements solutions that identify problems/root cause of issues.

• Identifies and resolves challenges in order to fulfill key corporate objectives and responds to the demands of change management and initiates actions needed to plan, organize, and control team activities.

• Independently develops and plans reports, papers, and/or other materials in a clear and concise manner.

• Provides high-level oversight and leadership.

• Acts as liaison between corporate business areas and participates in group or committee discussions.

• Recommends processes to control supply expenditures and promote efficient use of resources.

• Participates in the development of the annual departmental budget, monitors budget, and identifies budget discrepancies. Researches cause and make recommendations.

• Responsible for balancing workload to optimize the effectiveness of the department.

DIRECTION EXERCISED:

Directly supervises exempt and non-exempt staff in accordance with company policies and applicable Federal and State Laws. Responsibilities include, but are not limited to, effectively interviewing, hiring, terminating, and training employees; planning, assigning, and directing work; appraising performance; rewarding and counseling employees; addressing complaints and resolving problems; supporting and encouraging the engagement process.

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

EMPLOYMENT QUALIFICATIONS:

EDUCATION:

Bachelor's degree in Business Administration, computer science, Economics, Health Care, Information Systems, Statistics, or a related field. Master's degree preferred. Relevant combination of education and experience may be considered in lieu of a degree. Continuous learning, as defined by the Company's learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.

EXPERIENCE:

• Minimum of five (5) years of progressive work experience in Business/IT areas.

• Minimum of two (2) years' experience working/leading and implementing new programs in the Medicare Advantage, ACA, and/or Medicaid space.

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:

• Possesses and maintains extensive comprehensive knowledge of business, products, programs (including provider data, networks, etc.), corporate organizational structure (including functional responsibilities), and basic research principles/methodologies.

• Excellent analytical, planning, problem-solving, verbal, and written skills to communicate complex ideas.

• Strong working knowledge of data languages such as SAS or SQL.

• Strong understanding of Healthcare Government programs such as Medicare/Medicaid and ACA.

• Strong understanding of membership, claims, and provider data

• Strong understanding of CMS RAPS/EDPS submissions

• Strong understanding of CMS response files MOR-C, RAPS returns, MAO-004 etc.

• Ability to work independently, within a team environment and communicate effectively with employees at all levels.

• Demonstrated mentoring and coaching experience

• Must be self-motivated and can work well under pressure.

• Proficient in current industry standard PC applications and systems.

• Must demonstrate leadership ability and team building skills to effectively supervise professional and non-professional staff and interact with all levels of management.

• Ability to work with and empower others on a collaborative basis to ensure the success of the unit team.

• Ability to effectively exchange information, in verbal or written form, by sharing ideas, reporting facts and other information, responding to questions, and employing active listening techniques.

• Ability to effectively present budgetary and/or cost information and respond to questions as appropriate.

• Ability to establish workflows, technical solutions, manage multiple projects, and meet necessary deadlines.

• Ability to introduce new ideas, processes, measures, and tools to improve healthcare performance

WORKING CONDITIONS:

Work is performed in an office setting with no unusual hazards.

The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.

We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an \"at-will\" basis. Nothing herein is intended to create a contract.