Duties: | This position provides support in the development, acquisition, analysis, interpretation, and management of a variety of highly complex data sources. Acts as a content expert for data and analytics supporting the CMS Risk Adjustment performance improvement, operations, strategy, and initiatives. • The MA Data Ops Developer will be responsible for building, enhancing, maintaining and automating data warehouse structures as well as owning data inflows and outflows that support the Medicare Advantage Risk Adjustment teams and efforts. • Design & Development, providing technical development expertise for designing, coding, testing, debugging, documenting, and supporting analytical applications consistent with the established specifications and business requirements for the Medicare Advantage Risk Adjustment teams to deliver business value; Maintains accurate, thorough, user-friendly written guides, desktop procedures, and policies on a variety of data-related topics; • System Integration, integrating software components, subsystems, facilities, and services data into the existing technical systems environment; assessing impact on other systems, and working with cross-functional teams to ensure positive project impact. • Data Governance, will be a lead on data validation and quality control with regards to Medicare Advantage Risk Adjustment • The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements. • Perform all other duties as assigned. |
Skills: | Required Job Skills • Demonstrates intermediate-level SQL skills. • Reviews and evaluates data & analyses for validity, accuracy, completeness, appropriateness of model selection, limitations, and valid interpretation of results. • Demonstrates technical proficiency with healthcare performance measures and member-level data including Risk Adjustment, and Medicaid Core measures. • Advanced understanding of CMS regulations, methodologies, and deliverables & familiarity with AHCCCS regulations, methodologies, and deliverables. • Collaborates with internal resources to design, create, test, and implement analytic tools (reports, dashboards, etc.) that support the Risk Adjustment initiatives and that improve data collection and reporting strategies (minimize duplication, redundancy, etc.). • Superior ability to quickly learn & understand, translate, and operationalize complex regulatory, contractual, technical, and clinical languages/terminology. • Ability to bridge clinical and technical information to a variety of audiences & drive communication of action plans to meet business needs. Required Professional Competencies • Exudes excellence by setting high standards of performance for self and all coworkers, demonstrates low tolerance for mediocrity, requires high-quality results and exhibits conscientiousness and high sense of responsibility. • Stimulates creativity with the ability to see broadly outside the typical status quo and is constantly open to and promotes new ideas. • Excellent troubleshooting, analytic and problem-solving skills with the ability to create and communicate effective solutions. • Ability to manage multiple tasks simultaneously in a demanding, fast-paced environment while keeping relevant others in the organization informed of progress. • Ability to successfully work with minimal supervision, seeks out and seizes opportunities, finds ways to surmount barriers, and takes lead roles in working with key stakeholders and other analysts. • Shares important and relevant information with the team. Proactively offers suggestions, provides resources, volunteers for assignments, and removes barriers to help the team accomplish its goals. Required Leadership Experience and Competencies • Superior ability to effectively engage various audiences under a variety of fast-paced and high-profile circumstances, orally and in writing. • Experience communicating with a high level of discretion and professionalism with regulators, auditors, providers, regulators, vendors, executives, and other stakeholders. • Ability to independently manage technical/complex, multi-staged projects from beginning to end. Preferred Professional Competencies • Successful experience designing, developing, and implementing integrated data/analytical systems for new health plans/lines of business. • Successful experience maximizing data capture with various network infrastructures, i.e., integrated medical-behavioral health providers, ACO, FQHC, mobile health. • Successful experience simultaneously managing multiple governmental lines of business. |
Education: | Required Skills & Work Experience • 3 years of SQL server experience including database management, ETL, data modeling, data warehousing, and reporting. • 3 years business intelligence tools (e.g., Power BI, Tableau, Qlik Sense), and reporting via dashboards and scorecards. • 3 years of experience in Medicare Risk Adjustment and related data sources. • 3 years of experience analyzing and interpreting underlying data and summary rates, identifying gaps and opportunities in trends in member-level data, acquiring new data sources, and regulatory reporting for a managed care/health plan organization; and • 3 years of experience in planning, participating, and managing technical/complex multi-faceted projects from beginning to end. Required Education • High School Diploma Preferred Work Experience • 5 years of SQL server experience including database management, ETL, data modeling, data warehousing, and reporting. • 5 years business intelligence tools (e.g., Power BI, Tableau, Qlik Sense), and reporting through dashboards and scorecards. • 5 years of experience in Medicare Risk Adjustment and related data sources. • 5 years of experience analyzing and interpreting underlying data and summary rates, identifying gaps and opportunities in trends in member-level data, acquiring new data sources, and regulatory reporting for a managed care/health plan organization; and, • 5 years of experience in planning, participating, and managing technical/complex multi-faceted projects from beginning to end. Preferred Education • Bachelor’s Degree in Health Informatics, Analytics, Computer Science or a related discipline, or 5 years of related experience |