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Manager, Risk Adjustment Modeling
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Full-time
- Manages the development, routine maintenance and continual improvement of a CMS HCC model for Medicare Advantage Part C and D, utilizing RAPS and EDPS data sources, CMS files (MMR, MOR, TRR, etc.)
- Manages the development, routine maintenance and continual improvement of an HHS HCC model for ACA Commercial products, utilizing EDGE reports and other internal and external data sources.
- Advises internal departments on the use and interpretation of risk scores and associated reports and datasets to enhance understanding and risk adjustment literacy within the enterprise.
- Supports Care Management and Utilization Management by using risk adjustment data to provide additional insight on members’ burden of illness.
- Collaborates with Data Science and Analytics & Data Divisions on risk adjustment data inputs to predictive modeling.
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