Serve as Subject Matter Expert (SME) for the data processing, reporting, and analytics required to support the Risk Adjustment department operations. Chief Architect for reporting and analytics in support of Risk Adjustment operations for multiple lines of businesses. Serves as key contact for both internal (L.A. Care) and external (Vendors, regulatory agencies, etc.) requestors for Risk Adjustment data and reporting. Work with the risk adjustment vendors and keeps up to date on the latest risk adjustment changes that regulatory bodies pass on to health plans as it relates to reimbursement reporting requirements. Brings identified concerns to Manager with recommendations for resolution.
Applies subject expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the project’s/program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.
Create and produce summary reporting artifacts to give the Risk Adjustment Department the ability to monitor its performance. Provide guidance and direction to the analyst, internal and external stakeholders with regards to reporting and analytics. Conduct and provide analytical insight to gaps in performance.
Continuously monitor and review the daily operations to identify areas of improvement and for automation process. Designs and creates processes for data extraction, summaries, and higher level analytic functions to create and use on data queries and stored procedures. Creates and maintains database for the Risk Adjustment team to improve the workflow in various operational areas of risk adjustment.
Understand the end to end requirements for XML and 837 data processing channels to provide impact analyses from regulatory changes to these processes, and data reconciliation gaps.
Perform other duties as assigned.