Business Intelligence Lead - Medicaid Risk Adjustment

Profile

Description

Humana Healthy Horizons - Medicaid Risk Adjustment (MRA) team is committed to advancing the related capabilities across the Medicaid line of business through the development and administration of national programs, cross functional coordination of Risk Adjustment activities, business development support, new market implementation, and ongoing wrap-around market support.

Humana Healthy Horizons - Medicaid Risk Adjustment (MRA) team is seeking a Business Intelligence Lead who will provide data-based strategic direction to identify and address business issues and opportunities. The Business Intelligence Lead will provide business intelligence and strategic planning support for business segments or the company at large. The Business Intelligence Lead work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The Business Intelligence Lead for Medicaid Risk Adjustment leads initiatives to analyze complex business problems and issues using data from internal and external sources.


Implements and manages Louisiana (ACG Johns Hopkins) and Ohio (CDPS Rx) risk adjustment models.
Works with others on the MRA team and cross-functionally with national leadership & market leadership and colleagues to establish logic for internal risk score calculations for LA/OH members.
Responsible for data strategy regarding member engagement and provider outreach within our Louisiana and Ohio markets.
Brings expertise or identifies subject matter experts in support of multi-functional efforts to identify, interpret, and produce recommendations and plans based on company and external data analysis.
Ensures that policies and procedures align with corporate vision.
Begins to influence department's strategy.
Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction.
Exercises considerable latitude in determining objectives and approaches to assignments.
Creates logic and builds processes associated with Medicaid risk adjustment.
Other responsibilities as determined by leader.


Required Qualifications


5 or more years of technical data analytic experience including at least: 2 years of SQL and 2 years of experience with Johns Hopkins ACG and/or CDPS Risk Adjustment models
Bachelor's degree and 8 or more years of technical experience in data analysis OR Master's degree and 4 years of experience
2 or more years of project leadership experience
Advanced experience working with big and complex data sets within large organizations
Experience analyzing data to solve a wide variety of business problems and create data visualizations that drive strategic direction
Proven ability to work with cross-functional teams and translate requirements between business, project management and technical projects or programs
Proficiency in understanding Healthcare related data
Proficiency in verbal/written communication to senior and executive leadership
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
Satellite and Wireless Internet service is NOT allowed for this role.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information


Preferred Qualifications


Advanced Degree in a quantitative discipline, such as Mathematics, Economics, Finance, Statistics, Computer Science, Engineering or related field
Advanced in SQL, SAS and other data systems
Experience with tools such as Tableau and Qlik for creating data visualizations
Expertise in data mining, forecasting, simulation, and/or predictive modeling
Experience creating analytics solutions for various healthcare sectors


Additional Information

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

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Scheduled Weekly Hours

40

Company info

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