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Sr. Risk and Performance Analyst

Company Name:
Brine Group Staffing Solutions
Sr. Risk and Performance Analyst
Location: 5 miles Northwest of Boston

Our client is transforming in an Accountable Care Organization (ACO): a healthcare organization characterized by a payment and care delivery model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients.

As part of this transformation, out client has created an Accountable Care department. The department has a need for a Senior Risk and Performance Analyst. This Senior Analyst role requires in-depth understanding of financial and clinical healthcare data for risk stratification and performance improvement initiatives. Understanding of detailed clinical codes and episode-build, data utilized in risk software tools, and experience in application of risk tools are key skill sets for this role.


Responsibilities:

Understand inpatient and ambulatory claims coding schemes, categories of
services
, and apply judgment around invalid, incomplete or unreliable data to initiate remediation steps if warranted.
Retrieve, integrate, and analyze medical and pharmaceutical claims data.
Utilize claims data to develop and analyze financially sound leading and trailing cost and utilization indicators.
Monitor output from risk assessment tools and manage related data streams, including applications related to the DSTI initiative.
Support data submission for internal and external initiatives. Utilize statistical and economics principles, and reporting tools to analyze, interpret, and develop presentations.
Qualifications:
Bachelor's degree in finance, healthcare, statistics, or a related discipline. Masters preferred.
3+ years of experience of five years in managed health care/insurance setting.
In-depth knowledge of financial and clinical data.
Proficiency in using MS tools, including presentation software.
Experience in using SQL and/or SAS and BI tools to query databases .
EPIC systems experience a plus.

All qualified candidates can contact Jeff Brine at 781-272-3400 x220, or email:

All communication will be held in strictest confidence

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