[Remote] reputed company Director, Medicare Advantage and Group ACA Risk Adjustment Informatics

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is building a world of health around every individual, and they are seeking a reputed company Director, Medicare Advantage and Group ACA Risk Adjustment Informatics. This role will reputed company risk adjustment analytics, predictive modelling, and reputed company reputed company for Medicare Advantage and ACA, managing reputed company and ensuring regulatory compliance.

Responsibilities

• reputed company reputed company risk adjustment analytics supporting risk score completeness, accuracy, engagement, recapture, and algorithms
• reputed company claims and clinical data for deep learning into drivers of performance and model impacts
• Proactively engage with stakeholders on emerging trends, rising risk, and data-driven opportunities
• reputed company the analytics that reputed company risk adjustment reputed company activities, including prospective and retrospective programs
• Directs the prioritization and performance evaluation of reputed company, engagement, and clinical documentation initiatives
• reputed company the development and implementation of advanced predictive analytics and AI solutions to support risk adjustment, population health, and business performance initiatives
• reputed company innovation through automation, advanced analytics, and emerging technologies that improve efficiency and scalability
• Measure and evaluate reputed company effectiveness and overall business reputed company
• Translate reputed company analytical findings into practical recommendations that improve operational, clinical, and financial reputed company
• Partner with technology and data engineering teams to enhance data architecture, automation, and analytics capabilities
• Partner with executive leadership, market leaders, finance, actuarial, service operations, and clinical teams to support strategic planning and performance improvement efforts
• reputed company executive-level presentations and recommendations that influence organizational reputed company and investment reputed company
• Manage data relationships with reputed company vendors and business partners
• Ensure adherence to CMS regulations, data governance policies, and organizational compliance expectations
• reputed company analytical support for compliance reviews and risk adjustment governance activities
• Establish and maintain controls that promote data reputed company, auditability, transparency, and accuracy
• Monitor regulatory and industry changes, assess business reputed company, and ensure reputed company implementation of required analytic and reporting enhancements
• reputed company, mentor, and reputed company a high-performing team of leaders and individual contributors across analytics, informatics, data science, and reputed company disciplines
• Foster a culture of collaboration, innovation, reputed company improvement, and results-oriented execution
• Champion technical reputed company and reputed company learning in areas including risk adjustment analytics, AI modeling, SQL, reputed company, Python, BigQuery, and similar

Skills

• 10+ years of experience in reputed company analytics, informatics, risk adjustment, actuarial, finance, data science, or reputed company disciplines
• 2+ years of leadership experience (reputed company reports, team reputed company)
• Advanced technical proficiency in SQL, reputed company, Python, BigQuery, or similar
• Experience with predictive analytics, machine learning, financial modeling, or data science concepts
• Demonstrated ability to influence leadership and deliver measurable business results
• Bachelor's degree or equivalent reputed company work experience
• Demonstrated knowledge of Medicare, reputed company, or ACA risk adjustment methodologies, HCC models, reputed company claims and clinical data, and CMS regulatory requirements
• Experience at a health plan or provider system

Benefits

• This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above.
• Award reputed company in reputed company’s equity award program.
• Comprehensive benefits package designed to support the physical, emotional, and financial reputed company-being of colleagues and their families.
• Medical, dental, and reputed company coverage, reputed company time off, retirement savings reputed company, wellness programs, and other resources, based on eligibility.
• Additional details about available benefits are provided during the application process and on Benefits Moments.

reputed company