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Blue Cross and Blue Shield of Nebraska (BCBSNE) is more than just an insurance company; we exist to be there for people in the best and hardest moments of their lives.
Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there's no greater time for forward-thinking professionals like you to join us in delivering on it!
As a member of Team Blue, you'll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.
BCBSNE is happy to offer four work designations for our Omaha area employees: 100% in-office, Hybrid options, and 100% remote. If choosing to work remote, this role can be located in one of the following states: Colorado, Florida, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and Texas.This position is responsible for the oversight of the analytic functions of the Medicare Adjustment and Commercial (ACA) risk adjustment programs area.
What you'll do:
Oversee data analytics, report creation, data reviews, dashboard creation, and updates for the assigned team.
Drive data improvements for the department.
Responsible for vendor relationships, including data validation and extract updates.
Manage a team of business analysts. Responsibilities include data submissions relevant to risk adjustment, remaining current on Centers for Medicare & Medicaid Services (CMS) requirements, communicating, confirming completion of any data changes required, and supporting any Risk Adjustment Data Validation (RADV) functions.
Collaborate with internal and external stakeholders involved in risk adjustment data submission, as well as all other mandatory aspects.
Interact with leadership to create predictive models using information obtained from data mining or analysis.
Conduct gap analysis, data collection and validation related to risk adjustment activities,
Produce recurring and ad-hoc reports for business stakeholders for risk adjustment optimization.
Lead, manage, and develop direct reports, conducting quality reviews of their work and providing feedback as needed.
To be considered for this position, you must have:
Bachelor's degree in computer science, information systems, analytics, business, healthcare administration, or another relevant academic field.
5+ years' experience in a health care environment, including experience with Medicare Advantage (MA) or Affordable Care Act (ACA) risk adjustment data analytics or an equivalent experience.
Understanding of medical coding systems (including but not limited to CPT, ICD-10, DRG).
Previous supervisory or team lead experience.
Proficient SQL knowledge, including database management, query analysis.
Strong planning, organizational, interpersonal, verbal, and written communication skills.
Proficiency with Microsoft applications.
Demonstrated ability to work in high paced environment, handling multiple responsibilities and projects.
An equivalent combination of education and experience may be substituted for this requirement.
The ability to meet or exceed the attendance and timeliness requirements of their departments.
The ability to work well in a team environment and be capable of building and maintaining positive relationships with other staff, departments, and customers.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and or ability required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned.
The strongest candidates for this position will also possess:
Strong knowledge of the Health and Human Services (HHS) and/or CMS risk adjustment models, concepts, payment methodologies and submission requirements.
Proficiency with visualization tools such as PowerBI and/or Tableau.
Expertise/experience with Agile project delivery methodology for software development.
Learn more about what makes BCBSNE such an exceptional place to work by visiting NebraskaBlue.com/Careers.
We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.
Blue Cross and Blue Shield of Nebraska is an Equal Opportunity /Affirmative Action Employer - Minorities/Females/Disabled/Veterans