Lead Risk Adjustment Actuary
Our Client is seeking a Lead Actuarial Consultant that will manage risk adjustment workflows, focusing on risk score model development, claims scoring, and forecasting. This role also supports coding accuracy and evaluates impacts on risk scores and revenue, with a focus on ACO REACH and MSSP programs. Cross-functional collaboration is required.
Responsibilities:
Develop and maintain risk scoring models using claims data.
Lead quarterly risk adjustment analysis and forecasting.
Document and present analysis summaries.
Evaluate financial impacts of provider participation in ACO REACH and MSSP models.
Develop forecasting models for business decision-making.
Conduct ad-hoc data analysis (Excel, SAS, SQL).
Qualifications:
8+ years of actuarial experience, with 5+ years in healthcare.
3+ years of experience in risk adjustment modeling.
Experience with ACO REACH and MSSP programs.
Knowledge of risk-based models and value-based contracts.
Project leadership experience.
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