Director MRA Analytics

People. Passion. Purpose.

At P3 Health Partners, our promise is to guide our communities to better health, unburden clinicians, align incentives and engage patients. We are a physician-led organization relentless in our mission to overcome all obstacles by positively disrupting the business of health care, transforming it from sickness care into wellness guidance. If you are passionate about your work; eager to have fun; and motivated to be part of a fast-growing organization, then you should consider joining our team.

Overall Purpose

The Director of MRA Analytics will lead a team of analysts to ensure streamlined flow of encounter data from multiple data sources to P3’s health plan partners and ultimately to CMS. Additionally, they will work with P3’s vendor partners and health plans to build member level insights to inform strategic enterprise and market interventions. This position will be responsible for analytics supporting risk score accuracy to support budgets and quarterly forecasts and interface with various departments across the organization to ensure appropriate explanations of any material variances to expectations. This position requires someone who is adept at problem solving and the ability to communicate effectively with internal & external constituents.

Essential Functions

• Dashboard Development & Maintenance
  • Work with vendors and internal teams on ensuring accuracy of data being presented
  • Ensure continued evolution of dashboard development both externally and internally
  • Ensure SVP of Healthcare Econ has update and accurate materials to present to Markets, Health Plans, leadership and the Board.
  • Work with the Director of Medicare Programs to manage and maintain the coding dashboard
• End to End Encounter Reconciliation
  • Build and improve the reconciliation for all encounter data including ASM submissions
  • Ensure that P3 receives all data from health plans and that P3 vendor partners receive complete data sets
  • Manage a team to resolve submission errors and continue to build checks to reduce submission errors including the ability to link supplemental submissions to claims
• Strategic Initiative Guidance
  • Respond to requests for analysis and provide analytic support to the Market Leaders, ELT and external partners
  • Work with vendors and markets to approve and manage target lists for Chart Reviews
  • Monitor the performance of the Prospective program to identify areas for improvement
  • Work with Market teams and MRA leadership to identify strategies to implement In Home Assessment initiatives
  • Identify provider education opportunities based on coding results, queries, prospective performance and/or prevalence
• Financial Insights and Reconciliation
  • Manage revenue trend models and identify route cause of developing trends.
  • Manage all analytical audit requests as they relate to Medicare RADV and OIG and prepare financial impacts estimations.
  • Assist in creating the documentation and sign-offs required for SOX Control Audits.

Knowledge, Skills, and Abilities

• Proficiency in SQL
• Data Visualization Experience (Tableau or Power BI)
• Strong communication and strong written skills as well as proficiency with Microsoft Power Point
• Working knowledge of the provider-based healthcare industry, claims processing, provider billing or Risk Adjustment or Medicare Advantage strongly preferred
• Self-motivated, creative problem solver who can work independently, see the bigger picture and collaborate through strong communication and interpersonal skills
• Strong project management experience and ability to handle multiple projects in a fast-paced environment.

Experience

• At least 5 years previous work experience within risk adjustment
• Experience with CMS risk adjustment payment methodologies

Education

• Bachelor’s degree from an accredited institution.

Licenses

• Credentialed Associate of the Society of Actuaries (ASA) - preferred

Travel Details

• Periodic travel to Corporate Headquarters
• Ad hoc travel to Markets or other partner locations