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Risk Adjustment Data Scientist

Blue Cross Blue Shield of Kansas

Topeka, Kansas

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JOB DETAILS
SKILLS
Algorithms, Analysis Skills, Best Practices, Business Intelligence, Business Support, Centers for Medicare and Medicaid Services (CMS), Communication Skills, Computer Science, Continuous Improvement, Cross-Functional, Data Analysis, Data Cleaning, Data Collection, Data Management, Data Modeling, Data Processing, Data Quality, Data Science, Data Sets, Data Visualization, Data Warehousing, Demographics, Dental Insurance, Documentation, EDGE (Enhanced Data for GSM Evolution), Fitness, Forecasting, Health Insurance, Healthcare, High School Diploma, Identify Issues, Incentive Programs, Industry/Trade Analysis, Machine Learning, Mathematical Modeling, Mathematics, Needs Assessment, Performance Management, Performance Modeling, Predictive Modeling, Problem Solving Skills, Process Modeling, Programming Languages, Regulatory Compliance, Reporting Dashboards, Risk, Risk Modeling, Server Hardware, Software Specification, Statistics, Team Player, Test Plan/Schedule, Time Management, Training Program, Training/Teaching, Trend Analysis, Vision Plan
LOCATION
Topeka, Kansas
POSTED
5 days ago
Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.

You Belong At Blue

Why Join Us?

  • Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
  • FamilyComes First: Total rewards package that promotes the idea of family first for all employees. Paid vacation and sick leave with paid maternity and paternity available immediately upon hire
  • Professional Growth Opportunities: Advance your career with ongoing training and development programs.
  • Dynamic Work Environment: Collaborate with a team of passionate and driven individuals in a work environment that promotes flexibility.
  • Trust and Stability: Work for one of the most trusted companies in Kansas with over 80 years of commitment, compassion and community.
  • Inclusive Work Environment: We pride ourselves on fostering a workplace where everyone is valued and respected.

Benefits & Perks

  • Base compensation is only one component of your competitive Total Rewards package
    • Incentive pay program (EPIP)
    • Health/Vision/Dental insurance
    • 6 weeks paid parental leave for new mothers and fathers
    • Fertility/Adoption assistance
    • 2 weeks paid caregiver leave
    • 401(k) plan matching up to 5%
    • Tuition reimbursement
    • Health & fitness benefits, discounts and resources

Job Summary

The Risk Adjustment Data Scientist is responsible for analyzing and interpreting complex data, developing models and algorithms, and deriving actionable insights to support the business. The Data Scientist will work closely with cross-functional teams to understand business needs and deliver data-driven solutions.

What you'll do

  • Data Analysis & Interpretation: Analyze large and complex data sets from various sources to identify trends, patterns, and correlations. Translate data findings into actionable insights and recommendations.
  • Model Development: Develop, test, and deploy predictive and prescriptive models and scenario forecasting using machine learning and statistical techniques. Continuously evaluate and improve model performance.
  • Data Visualization: Create compelling data visualizations and dashboards to communicate findings and insights to both technical and non-technical stakeholders.
  • Collaborate & Communicate: Work with business stakeholders to understand their needs and translate them into data-driven solutions. Present findings and recommendations in a clear and concise manner. Support teammates by maintaining up-to-date, thorough, and clear documentation on data sources, preparation processes, mathematical models, dashboards, and other business intelligence activities.
  • Data Management: Ensure data quality, integrity, and security. Develop and implement processes for data collection, cleaning, and preparation.
  • Research & Innovation: Stay current with the latest industry trends, tools, and technologies. Explore and implement new methodologies to enhance data analysis capabilities.
  • Data Submission: Ensure accurate and timely collection of all risk adjustment data in compliance with applicable regulatory guidelines. Validate the completeness and integrity of data prior to submission, including diagnoses, demographic information, and provider documentation. Coordinate with internal teams and external partners to resolve data discrepancies or errors identified during the submission process.

What you need

Education and Experience:
  • High school diploma or equivalent required. Bachelor's degree in computer science, statistics, mathematics, engineering, or a related field preferred. In lieu of degree, a minimum of an additional 3 years' experience as a data analyst, data scientist, or related role required.
  • Minimum of 3 years' experience as a data analyst, data scientist, or related role required.
  • Experience with and knowledge of the healthcare delivery system and the health insurance industry preferred.
  • Master's degree preferred.
  • Experience with the federal risk adjustment model and CMS (Centers for Medicare and Medicaid Services) reporting requirements preferred.
  • Familiarity with EDGE (external data gathering environment) server hardware and software specifications and experience with EDGE server data submissions preferred.
  • Understanding of data warehousing concepts and best practices preferred.
Knowledge/Skills/Abilities
  • Technical Skills: Proficiency in programming languages such

About the Company

B

Blue Cross Blue Shield of Kansas

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