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Award-winning: Sentara is a Virginia and Northeastern North Carolina based not-for-profit integrated healthcare provider that has been in business for over 131 years. Offering more than 500 sites of care including 12 hospitals, PACE (Elder Care), home health, hospice, medical groups, imaging services, therapy, outpatient surgery centers, and an 858,000 member health plan. The people of the communities that we serve have nominated Sentara “Employer of Choice” for over ten years. U.S. News and World Report has recognized Sentara as having the Best Hospitals for 15+ years. Sentara offers professional development and a continued employment philosophy!
Sentara Health is looking for a Senior Risk Adjustment Data Analyst to join our team!
This position is 100% Remote, but candidates must have a current residence in one of the following East Coast states, or be willing to relocate: Delaware, Florida, Georgia, Maine, Maryland, New Hampshire, North Carolina, Pennsylvania, South Carolina, Virginia , West Virginia
The Senior Risk Adjustment Data Analyst provides data analysis supports to Sentara Health Plans’ Revenue Management team, affiliated internal departments, and external vendor partners. The Senor RA Analyst supports in designing and implementing processes and solutions utilizing a wide variety of data sets to resolve business challenges in relation to optimizing Risk Adjustment premium revenue. The senior analyst uses a combinations of data/text mining, analysis, reporting, predictive and risk modeling to support informed business decisions. This requires complete understanding of claims, pharmacy, lab, network utilization, and cost containment data. Additionally, familiarity with external data sources including Medicare, Medicaid, and Health Exchange data files is required.
The Senior RA Data Analyst is required to show independent thinking. The senior analyst assists in identifying business challenges, support development of processes to address the challenges, and metrics to track and monitor business processes. This requires a high level of understanding of Centers for Medicare and Medicaid (CMS), Health and Human Services (HHS), or Virginia Department of Medical Assistance (VA-DMAS) Risk Adjustment programs. The Senior RA Data Analyst must
- Serve as SME for standard analytic suites using EDP data sources for membership data and claims.
- Create and manage tables in the revenue management sandbox.
- Design table layouts and collaborate with the enterprise data team to develop new tables.
- Partner with architecture teams to build new and necessary data sources.
- Project Involvement: Collaborate with vendors on risk adjustment initiatives.
- Created necessary reports for business and regulatory use.
- Automated existing reports to improve efficiency.
- Developed and maintained dashboards for data visualization.
Education
Bachelor's Degree in Mathematics, Statistics, Finance, Economics, Computer Science, or related
Certification/Licensure
- No specific certification or licensure requirements
Experience
- 3 – 5 years in data analysis, predictive modeling, Medical Economics or related
- Advanced Knowledge of SQL AND databricks is required.
- Ability to break out complex technical processes and explain to non-technical audiences
- Understanding of Prospective and Retrospective Risk Adjustment Interventions preferred
- Excellent Oral and Written Communication Skills
- Problem Solving
- Consultative Engagement Skills
Keywords: Risk adjustment , SQL, Databricks, claims
We provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay rate for Full Time employment is: $60,756 – $101,254. Additional compensation may be available for this role such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Sentara prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
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