Risk Adjustment Consulting, Senior
Company: Blue Shield of California
Posted on: June 6, 2021
Risk Adjustment Analyst, Senior - In-Home Visits This position
is part of the Blue Shield Risk Adjustment team within Finance
Department and will work within a team to support the In-Home Visit
(IHV) Program. The Analyst will provide essential analytical
support to ensure success of the IHV program including tracking of
performance metrics against goals and providing actionable insights
into variances to goals.
To create an effective team, every individual must have:
- The desire to support Blue Shield Promise's missions, goals and
the member population which we serve.
- Excellent interpersonal/communication skills across various
media (written, verbally in meetings and over-the-phone)
- The ability to engage and collaborate with others in a team
setting to successfully complete projects
- The ability to prioritize and manage projects/timelines to
achieve successful outcomes
- Have strong analytical skills
- The ability to work in a fast-paced environment with dynamic
- Track In-home visits performance metrics (weekly) by vendor
- Production of IPA Reporting packet/reporting suite
- Calculation of ROI (monthly) by In-home visit vendor
- Data reconciliations (weekly/monthly)
- Member incentive processing
- Invoice reconciliations and processing
- Outreach list creation and coordination of refreshes
- Analytics to improve outreach identification
- Data submission
- Requires minimum of a bachelor's degree in a technical or
- At least 3 years of healthcare experience, with at least 2
years in a data analysis role
- Excellent interpersonal, verbal and written communication and
presentation skills - especially presentations of complex,
technical information to non-technical audiences and from
non-technical information to technical information.
- Independent problem solver, proactive, able to multitask.
Patience for working on large scale problems.
- Proficient in SQL / SAS and other data/analytic tools.
- Proficient with MS Office (Excel, Word, PowerPoint and
- Knowledge of healthcare management in Provider Relations,
Contracting, Member Enrollment, Claim Process, Medical Payment and
Revenue Reporting, and Encounter submissions and measures.
- Has Commercial or Medicare Risk Adjustment experience
- About Company: At Blue Shield of California we are parents,
leader, students, visionaries, heroes, and providers. Everyday we
come together striving to fulfill our mission, to ensure all
Californians have access to high-quality health care at a
sustainably affordable price. For more than 80 years, Blue Shield
of California has been dedicated to transforming health care by
making it more accessible, cost-effective, and customer-centric. We
are a not-for-profit, independent member of the Blue Cross Blue
Shield Association with 6,800 employees, more than $20 billion in
annual revenue and 4.3 million members. The company has contributed
more than $500 million to Blue Shield of California Foundation
since 2002 to have a positive impact on California communities.
Blue Shield of California is headquartered in Oakland, California
with 18 additional locations including Sacramento, Los Angeles, and
San Diego. We're excited to share Blue Shield of California has
received awards and recognition for - LGBT diversity, quality
improvement, most influential women in corporate America, Bay
Area's top companies in volunteering & giving, and one of the
world's most ethical companies. Here at Blue Shield of California,
we're striving to make a positive change across our industry and
the communities we live in - Join us!
- Physical Requirements:
Office Environment - roles involving part to full time schedule
in Office Environment. Based in our physical offices and work from
home office/deskwork - Activity level: Sedentary, frequency most of
Please click here for further physical requirement detail.
- EEO Footer: External hires must pass a background check/drug
screen. Qualified applicants with arrest records and/or conviction
records will be considered for employment in a manner consistent
with Federal, State and local laws, including but not limited to
the San Francisco Fair Chance Ordinance. All qualified applicants
will receive consideration for employment without regards to race,
color, religion, sex, national origin, sexual orientation, gender
identity, protected veteran status or disability status and any
other classification protected by Federal, State and local
- Requisition ID: 21001DS
- Posting Date: Apr 13, 2021
- Schedule: Full-time
Keywords: Blue Shield of California, Oakland , Risk Adjustment Consulting, Senior, Other , Oakland, California
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