Risk Adjustment Actuary - Remote

Overview

An overview paragraph about the job

In Short

• Being the primary risk adjustment analytics and modeling expert at Zing
• Working with Risk Adjustment Operations, Value-Based Partners, and other business stakeholders to understand risk adjustment performance and opportunities
• Tracking and reporting ROI of various Risk Adjustment initiatives
• Develop and maintain an industry-leading HCC recapture analytics and reporting suite
• Support efforts for compliant HCC suspecting
• Quantify the financial opportunities and impacts of risk adjustment activities such as Annual Wellness Visits and Chart Chase Programs.
• Own and maintain an internal Risk Score calculator using programming languages (SQL, Python)
• Own and maintain monthly risk score accrual methodology, process, and deliverables
• Stratify Zing’s membership for accurate coding initiatives
• Risk score development for Bids and Forecasting
• Maintain a culture of compliance around Medicare Risk Adjustment

Requirements

• ASA or FSA credentials
• 5+ years of direct Medicare Advantage work experience, ideally with significant exposure to the Medicare Risk Adjustment program
• Ability to write new and modify existing SQL and Python code
• Detailed knowledge of the CMS v24 HCC, v28 HCC, and RxHCC risk adjustment models
• High degree of attention to detail
• Ability to work effectively frequently with other departments beyond Actuarial
• High degree of independence and self-determination

Benefits

• Details about benefits are not provided in the job description.