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Johns Hopkins Medicine Healthcare Business Analyst, Medicare Advantage in Glen Burnie, Maryland

Healthcare Business Analyst, Medicare Advantage

Johns Hopkins Health Care,
Glen Burnie, MD
Requisition # 158390
Day Shift
Full Time (40 hours)
Weekend Work Not Required

Johns Hopkins Health System employs more than 20,000 people annually. Upon joining Johns Hopkins Health System, you become part of a diverse organization dedicated to its patients, their families, and the community we serve, as well as to our employees. Career opportunities are available in academic and community hospital settings, home care services, physician practices, international affiliate locations and in the health insurance industry. If you share in our vision, mission and values and also have exceptional customer service and technical skills, we invite you to join those who are leaders and innovators in the healthcare field.

Under minimal supervision, is responsible for developing, implementing, and monitoring all aspects of a Risk Adjustment program for Medicare Advantage to include; data acquisition, quality review, submission and reconciliation of vendor data to CMS, effective forecasting for both the clinical and financial impact of the data to the organization. They will provide appropriate and data-driven guidance to operational areas in their efforts to optimize revenue and pursue clinical quality efforts through health care data analysis, data management, quality improvement studies, dashboard development, statistical analysis, and report generation.

Key Accountabilities:

  • Conduct research and analysis of healthcare data related to Medicare Advantage membership specific to providers, claims, utilization, pharmacy, and financial data

  • Design methodology of and conduct investigative research to uncover root causes, interpret results, identify trends, and make recommendations for action

  • Ensure compliance with CMS data submissions

  • Data analysis and reconciliation of RAPS and EDPS data submission and vendor oversight

  • Create and report out ROI on variety of initiatives to targeted populations to support efforts

  • Develop and support risk score forecast and reconciliation process to support organization budget and accrual process

  • Develop databases to capture metrics and productivity related to provider gaps in care and HCC reports

  • Ensure accurate calculation of CMS risk scores for Medicare Advantage members; create geographical and competitive comparisons and analyses

  • Support the creation of prospective gap closure strategy using predictive modeling and data mining results to identify gaps

Required qualifications and skills

Bachelor’s degree in business, finance, actuarial science, economics or related

Strong working knowledge of relational database principles including SQL Server Management Studio, SAS PROC SQL, Microsoft Office Products, such as Access or Excel

3 years of healthcare reporting and analysis, preferably within a managed care environment

Excellent quantitative and analytical skills with the ability to interpret findings graphically, verbally, with well written results

Johns Hopkins Health System and its affiliates are Equal Opportunity/Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identity, sex, age, national origin, disability, protected veteran status, and or any other status protected by federal, state, or local law.