Senior Risk Score Data Analyst

Mass General Brigham Health Plan
United States, Massachusetts, Somerville
399 Revolution Drive (Show on map)
Apr 23, 2025
Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world's leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage. Our work centers on creating an exceptional member experience - a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills. We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more. Under the direction of the Risk Score Manager, this analyst is responsible for providing primary analytic support to the Risk Score Management program with the objective of improving the accuracy of member risk profiles. This analyst will develop and produce reports based on risk adjustment data from several data sources, work with both internal and external departments to identify opportunities for risk score improvement, and manage multiple risk score projects. This analyst will be responsible for targeted member tracking for medical record audits and outreach, vendor management and provider engagement. This analyst will be required to lead analytic projects with minimal supervision, as well as mentor and train other analysts in both the Risk Score Management department and other departments within the organization that also use the data, such as Medical Economics and Clinical. ESSENTIAL FUNCTIONS * Creates and produces risk adjustment analyses for Risk Score department, senior leadership, internal and external customers * Utilizes several different risk adjustment calculation and reporting software tools, and is able to merge and analyze data from several different sources * Completes sophisticated analyses of claims and risk adjustment data using SQL and/or SAS * Manages the analytic component of complex departmental projects such as vendor-assisted chart reviews and in home medical assessments * Completes ad-hoc analyses to support internal customers * Evaluates the accuracy of diagnosis coding and documentation in medical records for audits as well as for identifying common issues that result in either under coding or over coding * Develops strategies for provider training, education and medical management * Evaluates data quality of internal and external datasets * Anticipates and meets, or exceeds, internal and/or external customer expectations and requirements; establishes and maintains effective relationships with customers and gains their trust and respect. * Hold self and others accountable to meet commitments. * Build strong customer relationships and deliver solutions that meet customer expectations; establish and maintain effective customer relationships - both internal as well as external. * Other duties as assigned with or without accommodation. Qualifications Bachelor's degree required or the equivalent combination of training and experience, Master's degree preferred At least 5-7 years of experience in data analysis, financial reporting, or risk management At least 3-5 years of experience with data analysis tools and software such as SQL, R, Python, or similar Preferred: Prior experience working for a health plan or in a managed care setting Experience using query tools such as SQL and/or SAS Advanced Excel, Visual Basic, and/or other reporting skills Experience and skill working with large, complex datasets Experience with risk adjustment data Knowledge of procedure and diagnosis coding methods (CPT-4, ICD-9, ICD-10, HCPCS, NDC) Experience with DxCG risk adjustment data Experience with ACA Commercial risk adjustment Experience with Medicaid and/or Medicare risk adjustment Knowledge, Skills, and Abilities Strong analytical skills for interpreting complex data sets and drawing actionable insights Detail-oriented with a focus on data quality, accuracy, and data integrity Proficiency in data visualization and presentation, with experience using tools like Tableau or PowerBI Ability to collaborate effectively across teams and communicate technical findings to non-technical stakeholders Knowledge of healthcare financial reporting and risk assessment standards Working Conditions This is a remote role that can be done from most US states The role is Monday- Friday with standard business hours in Eastern Time Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.