Lead Actuarial Consultant – Risk Adjustment
| Company | NeueHealth |
|---|---|
| Location | Texas, USA, Florida, USA, Minnesota, USA |
| Salary | $Not Provided – $Not Provided |
| Type | Full-Time |
| Degrees | Bachelor’s |
| Experience Level | Senior |
Requirements
- Bachelor’s degree required in Math, Statistics, Economics, Actuarial Science, or a related field
- Around 8 years of actuarial experience with 5 years working within healthcare, preferred
- 3+ years working with a CMS/HHS HCC risk adjustment modeling is required
- 2+ years working with a CMMI ACO Model (of any kind) is strongly preferred
- 2+ years working with individual/small group ACA rate filings or Medicare Advantage bids is preferred
- Working knowledge of the CMMI Direct Contracting or Accountable Care Organization (ACO) program(s)
- Working knowledge of industry value-based contracts between payers and providers (risk sharing arrangements)
- Experience leading projects and ownership of deliverables
Responsibilities
- Build, maintain, and own the CMS HCC risk scoring model with appropriate data filtering logic
- Lead quarterly risk adjustment analysis and forecasting for the Medicare Advantage and Medicare ACO populations
- Document and present summary review memos in support of the quarterly risk adjustment analysis and forecasting process
- Lead the evaluation of risk adjustment related financial implications of provider participation in networks for ACO REACH / MSSP opportunities
- Lead provider risk contract evaluations and ACO REACH / MSSP performance evaluations
- Collaborate with Operation Risk Adjustment team in the development of forecasting models, projections and relevant information to inform C-Level business decisions
- Perform ad-hoc data analysis using Excel, SAS, SQL (Databricks)
- Other duties and responsibilities as assigned
Preferred Qualifications
- Experience with forecasting, modeling, SQL (Databricks experience is a plus)
- Experience with SAS based tools (CMS risk adjustment models)
- Understanding of company practices related to management of member populations for purposes of estimating risk
- Produce, understand, and interpret internal and external analysis and reports; provide effective technical and non-technical support to internal and external stakeholders
- Associate of the Society of Actuaries is strongly preferred