Blue Cross and Blue Shield of Louisiana Senior Risk Adjustment & STARS Analyst (REMOTE) in Baton Rouge, Louisiana
We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross.
Please note that effective Jan. 4, 2022, Blue Cross and Blue Shield of Louisiana implemented a policy requiring any employee who enters any of our offices or who interacts in person with anyone for company business purposes to be fully vaccinated for COVID 19, unless legally entitled to a reasonable accommodation related to religious or medical exemptions. At this time, that policy is suspended and vaccination is not required to enter our facilities. Please note this is subject to change at any point in time to ensure compliance with company policy or government mandates and certain client facing roles may have separate protocols.
Residency in or relocation to Louisiana is preferred for all positions.
We will consider remote work in the following states: LA, AL, AR, DE, FL, GA, IN, IA, KS, KY, MS, MO, NH, NC, OK, PA (limited counties), SC, TN, TX, VA, UT, VA, WV, WI.
The Senior Risk Adjustment and STARS Analyst provides analytics understanding and improving the accuracy of diagnosis coding and improving overall Star Performance. This role also assists in the coordination of projects supporting Risk Adjustment and STARS processes. In collaboration with other business areas, this position assists in problem solving, solution development and strategic planning and decision making.
Accountable for complying with all laws and regulations associated with duties and responsibilities.
NATURE AND SCOPE
This role does not manage people
This job reports to: Departmental Leadership
Necessary Contacts: In order to effectively fulfill this position the incumbent must be in contact with the following: Health Services, Actuarial, Finance, IT, Marketing, Healthcare Analytics and Data, external vendors, government entities, Blue Cross Blue Shield Association and other BCBS plan partners.
Bachelor's in healthcare administration, statistics, economics, mathematics, analytics, computer science, finance, accounting business or quantitative/healthcare related field required.
Four years of related experience can be used in lieu of a Bachelor’s degree.
A Master’s degree in healthcare administration, statistics, economics, mathematics, analytics, computer science, finance, accounting business or quantitative/healthcare related field can substitute for 2 years’ experience. A doctorate degree in related field may be substituted for an additional two years of related work experience.
4 years of healthcare, analytics, IT or management consulting experience required.
Direct experience in Risk Adjustment decision support is preferred.
Skills and Abilities
Must have direct experience with query/analytic/visualization tools such as SQL, SAS, Access, R, Tableau, etc.
Strong critical thinking, analytical and problem solving skills are required.
Excellent verbal and written communication skills; strong interpersonal skills. Ability to analyze, consolidate and communicate complex technical topics to all levels of internal staff and external vendors
Knowledge of clinical grouper (HCC, ERG, DCG, and ACG), episode groupers (ETG/MEG/Cave Grouper) and quality metrics (HEDIS, AHRQ) is highly desired.
Strong understanding and direct experience with risk adjustment is required.
Working knowledge of the CMS STAR Program is preferred
Ability to perform multiple projects in a matrix organization.
Demonstrated success in managing projects is preferred.
Ability to communicate effectively with customers with varying technical/statistical acumen.
Basic knowledge of United States health care delivery system in payer setting or provider setting is preferred.
Licenses and Certifications
- Lean Six Sigma preferred
ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS
Performs scientific and technical planning, analysis, reporting and methodological support to measure and improve medical diagnosis coding and documentation.
Supports leadership in reporting to assist in the planning, implementation, and measurement of coding accuracy/RADV/STARS processes.
Responsible for coordinating, tracking, and measuring Risk Adjustment and STARS processes.
Serves as key SME and project coordinator for annual HHS RADV.
Collaborates with various business areas to improve overall Star Performance
Performs analytics and provides insights on Medicare Advantage STARS and coding accuracy.
Provides ongoing data analysis and recommends focus and direction of resources for decision makers and management that is relevant to the healthcare market; assists in problem solving, solution development, decision making, and strategic planning.
Hypothesizes and develops attributes that characterize or predict coding accuracy and STAR Performance.
Leverages reporting software and models to develop attributes on population(s) and identify opportunities to close gaps.
Performs peer data quality reviews, validating data and process to ensure accuracy, completeness, and consistency of department output; recommends process improvements as necessary. Investigates existing national and regional data and performs descriptive and analytic studies using basic analytical/statistical techniques.
Serves as technical expert advisor to collaborating departments on corporate and cross-functional projects, reports, and activities. Provides training and support to junior level staff.
Additional Accountabilities and Essential Functions
The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions
Perform other job-related duties as assigned, within your scope of responsibilities.
Job duties are performed in a normal and clean office environment with normal noise levels.
Work is predominately done while standing or sitting.
The ability to comprehend, document, calculate, visualize, and analyze are required.
An Equal Opportunity Employer
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In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.
Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.
Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.
JOB CATEGORY: Data Analytics/Warehousing, & Business Intelligence