Sr. Manager Health Business Analytics, Medicare Risk Adjustment - Remote

Florida Blue is committed to transforming health through technology-enabled care. The Sr. Manager Health Business Analytics role is responsible for overseeing and optimizing Medicare Risk Adjustment Programs, managing a team, and leveraging data to enhance revenue accuracy and ensure regulatory compliance.

Responsibilities:

• Oversee the end-to-end strategy for risk adjustment programs, including prospective and retrospective processes. This involves managing provider workflows, chart reviews, and coding validation to ensure accurate documentation under CMS-HCC models
• Partner with actuarial and finance teams to support bid development, producing defensible risk score projections, trend analysis, and revenue assumptions. This includes communicating results to executive leadership
• Manage work to produce customer value by planning and forecasting, setting objectives and priorities, establishing goals, clarifying accountabilities, assigning work and utilizing management and financial controls
• Lead analysis, provide recommendations, and represent Analytics
• Work closely with leaders across business areas to drive results across the business
• Manage levels of performance and assist with employees’ professional growth by planning and building an effective organization; communicating effectively; coordinating with others; maintaining employee morale; motivating, recognizing and rewarding others; coaching and developing others, and engaging in self-development
• Manage business and public relationships and situations to obtain better business outcomes; communicate effectively and coordinate with others
• Develop, prioritize and implement strategy; set policies and procedures and manage creativity and innovation with primary goal of impacting health business

Requirements:

• 8+ years related work experience. Experience Details: Strong Risk Adjustment experience in commercial and or Medicare
• 3+ years direct supervisory/management experience
• Related Bachelor's degree or additional related equivalent work experience
• Experience working with statistical methodologies and risk adjustment
• Experience writing SQL /SAS or related code to perform quantitative risk score analysis
• Advanced Excel skills
• Experience using algorithms and inferential statistics
• Expert consulting, negotiating, communicating, consensus building, presentation and facilitation skills
• In-depth business process knowledge of several key business functional areas
• Expert-level ability communicating highly complex information clearly and articulately for all levels and audiences
• Demonstrated leadership abilities including effective knowledge sharing and conflict resolution
• Experience communicating and presenting detailed business and financial information
• Ability to understand overall Analytics strategy and apply/implement the strategy in assigned projects/initiatives/programs
• Experience working within the healthcare insurance industry
• Bachelor's degree in a related field Business Analytics, Health Economics or similar program
• Master's degree in a related field