You Will Focus On:

• Create, monitor and audit performance dashboards used to monitor and evaluate patterns, costs, and trends as they relate to Risk Adjustment.
• Modify existing programs and write SAS, SQL or R programs for data extraction.
• Gather and clearly define and communicate business requirements and project goals
• Develop methods to support the access, storage, and reporting of data sets that result from project initiatives
• Assist and oversee with development of business strategy initiatives with leadership
• Effectively visualize and communicate the risks, insights, patterns, and trends from complex and disparate reports and sources
• Oversees the data to and from CMS submission systems (RAPS, EDPS) in collaboration with cross functional departments
• Proactively seeks training and builds knowledge/experience of technical tools, coding languages and data sources
• Collaborate and support risk adjustment and other department leadership teams
• Other duties and responsibilities as assigned

The Skills, Experience & Education You Bring:

• Bachelor’s Degree required in Actuarial Science, Math, Statistics, or in a related field of study
• Master’s degree in Science, Math, Statistics, or in a related field of study preferred.
• 3-5 years of experience analyzing and interpreting Medicare Advantage or ACO Risk Adjustment data with MA/ACO Risk Scoring methodology, including familiarity with condition categories (HCC)
• 1-2 years experience supporting the development of scalable analytic and reporting solutions.
• 3-5 years of experience in healthcare industry, with a focus on Risk Adjustment
• 1-2 years of experience interacting with large amounts of healthcare data to include but not limited to directly with the following CMS files (MMR, MOR, MAO-004, MAO-002,etc)
• 1 or more years working with clinical classification such as diagnoses (ICD), procedures (HCPCS, CPT) and claims processing
• 1 or more years working with data to and from submission systems (RAPS, EDPS, Edge), including background on filtering logic for each system
• 1 or more years’ experience writing SQL, SAS, R code or related code
• Extensive knowledge of CPT, ICD-10-CM, CMS-HCCs, E&M coding principles and guidelines

You Share our Mission & Values

• You are passionate about improving the healthcare experience and want to be part of the Altais mission.
• You are bold and curious- willing to take risks, try new things and be creative.
• You take pride in your work and are accountable for the quality of everything you do, holding yourself and others to a high standard.
• You are compassionate and are known as someone who demonstrates emotional intelligence, considers others when making decisions and always tries to do the right thing.
• You co-create, knowing that we can be better as a team than individuals. You work well with others, collaborating and valuing diversity of thought and perspective.
• You build trust with your colleagues and customers by demonstrating that you are someone who values honesty and transparency.