Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.
Are we growing? Absolutely—about 50% growth from 2015 through late 2019. Are we recognized? Definitely. Evolent was the first organization ever to receive NCQA’s Population Health Program Accreditation, and is consistently recognized as one of the Becker’s Healthcare 150 Top Places to Work. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.
Associate Director, Risk Adjustment Analytics
Evolent Health has built a world-class team to help forward-looking health plans and providers succeed under new value-based care payment models. Risk adjustment is one of the most significant quantitative challenges facing these innovators. Evolent’s team of experts in risk adjustment does it all – from data analytics & advanced modeling (e.g. predictive models & artificial intelligence), to designing, presenting, and implementing industry-leading solutions with our partners. We are looking for a Associate Director, Risk Adjustment Analytics to join this highly-advanced team of actuaries and data scientists to develop and maintain risk adjustment analytic capabilities.
- Manage the calculation and forecasting of risk scores as well as the projection of revenue changes due to risk adjustment
- Remain current with annual changes to national and state risk adjustment methodologies and payment parameters; communicate anticipated changes in risk adjustment and how they will affect future revenue
- Analyze and present relevant data to inform decisions related to entering risk-based relationships with payers managing risk
- Conduct analyses and develop reports to measure risk adjustment operations performance; collaborate with the data science team to identify actionable opportunities to gain operational efficiencies
- Support actuarial and finance teams to ensure risk-based reporting needs are satisfied for bidding, rate setting, and revenue projections
- Research and prepare evaluations on a variety of complex and diverse projects/problems related to risk adjustment
- Communicate results and analyses to internal and external stakeholders
- Lead, manage, and mentor analytical staff
The Experience You’ll Need (Required):
- Bachelor’s Degree
- 3-7 years of professional experience in an analytics role at a health plan/payer/insurer, healthcare analytics firm, consulting firm, or hospital system
- Understanding of risk scoring models (e.g., CMS-HCC, HHS-HCC, CDPS) and risk adjustment in healthcare
- Experience working with healthcare data (claims, encounter submissions, eligibility, etc.) & detailed knowledge of CPT/HCPCS/ICD9/ICD10
- Proven ability to approach complex problems and design, execute, and communicate data-driven solutions
- Data manipulation and analysis using SAS, SQL, Python, or other relational databases
- Motivation and a strong desire to focus on the complex challenge of risk adjustment in healthcare, develop our team, and contribute to industry thought leadership
Finishing Touches (Preferred):
- Graduate degree with a quantitative, healthcare, or technical focus (e.g., science, math, statistics, actuarial sciences, health services management, computer science, engineering, informatics)
- Actuarial Credentials (e.g. ASA or FSA)
- Prior employment or consulting experience with Medicaid MCOs
- Experience interpreting state Medicaid agency rate setting documentation
- Experience with predictive modeling or machine learning
- Exceptional Presentation Skills
Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.