Manager Hcc Risk Adjustment Jobs in Detroit, MI (NOW HIRING)

GENERAL SUMMARY:

Under the direction of the director, the Principal Financial Healthcare Data Analyst is responsible for completing comprehensive quantitative, financial, and operational analysis related to government program revenue. This position is responsible for building, maintaining, and enhancing data models, automated reporting processes, dashboards, and analytical tools to meet Health Alliance Plan's revenue reporting needs. The position will use internal and external data, modern data interrogation and visualization tools, and emerging technologies, including artificial intelligence (AI)-enabled productivity and analytics tools such as Microsoft Copilot, where appropriate and consistent with company policies, to improve reporting efficiency, insight generation, and decision support.

The position will provide expertise in automated reporting processes and procedures, analytical reporting, data quality review, and recommendations for meeting reporting goals. The position will collaborate with data stewards, technical teams, and subject matter experts to ensure financial goals are met and reporting outputs are complete, accurate, and well-controlled. The position will provide technical and analytical expertise to other internal departments and assist in presenting to and advising upper management and key stakeholders on forecasted plan revenue, project valuation, risk score impact on revenue, and recommended solutions. The position will serve as a subject matter expert in Accounting and Finance for Centers for Medicare & Medicaid Services (CMS) Hierarchical Condition Category (HCC) Risk Adjustment and its role in managing CMS revenue.

DUTIES AND RESPONSIBILITIES:

• Under the direction of the Director, utilize internal and external data sources to design, implement, and maintain data models for monthly accounting cycle reporting of government program anticipated revenue, annual reporting of Medical Loss Ratio (MLR), and annual accounting of subsidized pharmacy program funds related to Medicare Advantage Part C, Medicare Advantage Part D, and Medicare-Medicaid Program reporting.

• Monitor, interpret, disseminate information, and implement changes, as applicable to Medicare programs, based on Centers for Medicare & Medicaid Services (CMS) and/or State ongoing communications to health plans specific to the financial analyst role.

• Design and implement appropriate processes, quality checks, and control mechanisms to ensure that data models, data extracts, table updates, artificial intelligence (AI)-assisted outputs, and reporting logic are complete, accurate, explainable, and appropriately documented.

• Utilize data sets, financial acumen, and appropriate analytical tools to estimate the impact on revenue accruals for financial reporting and to report risk scores. Prepare and deliver well-organized reports that reflect risk adjustment project valuation, the basis for recommendations to revenue accruals, and the analytic methods used to determine findings.

• Serve as a primary user of the Hierarchical Condition Category (HCC) Risk Adjustment vendor application. Monitor vendor systems for assessment data submission and acceptance status, progress of risk projects, use of vendor supplemental data to assist in risk adjustment project pricing, and ongoing assessment of data integrity and completeness issues that may impact risk adjustment project valuation.

• Design processes to produce automated reports, dashboards, and data extracts at multiple reporting levels required within the organization, including contract, benefit plan, provider organization, and group levels.

• Support leadership in the development and implementation of strategic financial initiatives, product offerings, and other strategic business programs through the extraction, analysis and summarization of appropriate data sets and benchmarks.  Support to such projects include but are not limited to annual bid preparation, employer group rate renewals, financial reporting for Henry Ford Health corporate initiatives.

• Use modern productivity, analytics, and automation technologies, including artificial intelligence (AI)-enabled tools such as Microsoft Copilot, Microsoft Power BI, Microsoft Excel, structured query language (SQL), and other approved data interrogation tools, to enhance analysis, summarize findings, identify trends, and improve the efficiency and consistency of recurring financial reporting.

• Coordinate with leadership and multiple departments within the organization, including but not limited to Actuarial Services, Underwriting, Financial Analysis, Financial Services, Risk Adjustment, Information Technology (IT)-Business Intelligence, Provider Services, Network Management, Data Analytics, and Henry Ford Health Revenue Cycle for expertise in government programs, payment methods, revenue attribution, and risk adjustment.

• Design and implement appropriate processes and control mechanisms to ensure that generated reports reconcile to the general ledger.  Maintain documentation for reported accruals to support financial audit requirements and future reconciliation with Centers for Medicare & Medicaid Services (CMS) payments.

• Coordinate and communicate business unit functional requirements and technical solutions with Information Technology (IT) capability resources by designing and documenting functional specifications.  Develop and maintain policies and procedures specific to government revenue, risk score reporting, data governance, and appropriate use of approved analytics and artificial intelligence (AI)-enabled tools.

• Represent government program revenue and Risk Adjustment reporting needs on corporate subcommittees and workgroups when upgrades or changes are made to company or vendor systems or processes. Serve as a subject matter expert contributing to the development and tracking of internal dashboards, key performance indicators (KPIs), and other management reporting tools.

• Coordinate technical modifications with internal teams, including Information Technology (IT)-Business Intelligence, Risk Adjustment, and vendors, such as data extraction, automation enhancements, dashboard updates, reporting logic, and table updates to correct configuration issues affecting monthly reporting processes as required.

• Utilize Centers for Medicare & Medicaid Services (CMS) government program regulatory communications and knowledge of Risk Adjustment program operations, Risk Adjustment payment methods, and Hierarchical Condition Category (HCC) coding to assess the impact on government program financial reporting.

• Identify and drive continuous improvement initiatives that improve the efficiency, accuracy, transparency, and effectiveness of reports and reporting processes, including responsible use of automation, artificial intelligence (AI)-enabled tools, and modern analytics platforms.

• Perform other duties as assigned.