The Prospective Risk Adjustment Operations team is seeking a Director to lead advanced data science initiatives to optimize risk capture and support clinical and operational decision-making within prospective risk adjustment.
Requirements
- fluency in SQL, SAS, or Python
- strong grasp of healthcare claims data-including ICD, CPT/HCPCS, bill type, and revenue codes
- familiarity with risk extension submission systems such as EDPS and EDGE
- proficient in statistical modeling
- regression analysis
- variance normalization across markets
- ACA payment transfer modeling
Responsibilities
- designing and executing complex analytic strategies-including benchmarking, prevalence tracking, cohort stratification, predictive modeling, and suspecting logic-to optimize risk capture and support clinical and operational decision-making
- developing scalable analytic solutions that inform member targeting, provider engagement, and program compliance, while translating complex data into actionable insights
- drive data extraction, validation, and advanced analytics
- overseeing data and information collection on targeted variables in an established systematic fashion
- Directs data preparation for analytic efforts
- Oversees the execution of creative data analytic approaches leading to actionable outcomes across one or more functional areas, business and/or clinical lines
- Oversees the development, implementation, and automation of business and reporting strategies
Other
- This position is Flexible and the individual may reside in any KP authorized state including California, Oregon, Colorado, Washington, Hawaii, Georgia, Maryland and Washington DC.
- Demonstrates continuous learning and maintains a highly skilled and engaged workforce by aligning resource plans with business objectives; overseeing the recruitment, selection, and development of talent; motivating teams; preparing individuals for growth opportunities and advancement; staying current with industry trends, benchmarks, and best practices; providing guidance when difficult decisions need to be made; and ensuring performance management guidelines and expectations drive business needs.
- Experience in government-sponsored health programs such as Medicare Advantage or ACA is strongly preferred.
- synthesizing complex findings into clear, compelling narratives that support strategic decision-making and stakeholder alignment.
- building and leveraging partnerships with clients and staff to identify opportunities and methods to improve efficiencies with analysis
