Sr. Population Risk Performance Analyst (Value-Based Care)

📋 Description

• • As a Sr. Population Risk Performance Analyst at Blue Cross and Blue Shield of North Carolina, you will play a pivotal role in shaping the future of value-based care by providing advanced analytical and modeling expertise. This position is central to ensuring accurate, consistent, and defensible financial and quality performance measurement across our diverse value-based care programs.
• • Your primary responsibility will be to apply sophisticated population risk models to attributed member populations. This ensures that performance metrics truly reflect the underlying health needs of the members, providing a fair and accurate basis for financial and quality assessments.
• • You will be instrumental in operationalizing complex risk and actuarial modeling methodologies. This includes their application in total cost of care evaluations, performance reconciliation processes, forecasting future trends, and supporting provider settlement procedures.
• • This role demands a strong partnership with actuarial, finance, clinical economics, and value-based care operations teams. Your collaboration will ensure that performance outcomes are appropriately normalized for population acuity and align with the intended contractual measurement frameworks.
• • A key distinction of this role is its focus on performance measurement methodology and financial normalization, rather than coding-based risk adjustment functions. You will be the expert in how we interpret and apply risk models for performance evaluation.
• • You will operationalize established population risk methodologies, including CMS-HCC and Milliman, to rigorously evaluate performance and conduct financial measurements.
• • A significant part of your work will involve supporting the development and ongoing maintenance of risk-normalized total cost of care and quality performance metrics, ensuring they remain relevant and accurate.
• • You will be tasked with validating the performance measurement methodologies that underpin our shared savings, downside risk, and alternative payment models, ensuring their integrity and effectiveness.
• • Analyzing population risk movement and evaluating its impact on program financial performance and provider outcomes will be a core function, providing critical insights for strategic decision-making.
• • You will collaborate closely with actuarial and finance teams to ensure that modeling assumptions are in perfect alignment with the contractual measurement logic, preventing discrepancies and ensuring fairness.
• • Identifying and investigating performance variances, whether driven by population acuity, attribution changes, coding variations, or data completeness issues, will be crucial for maintaining the accuracy of our performance data.
• • You will provide essential support for performance year reconciliation, detailed settlement calculations, and thorough financial exposure analysis, safeguarding the company's financial health.
• • Defining and meticulously documenting measurement methodologies, underlying assumptions, and robust model governance controls will be a key deliverable, ensuring transparency and repeatability.
• • You will work hand-in-hand with analytics and data engineering teams to seamlessly integrate risk modeling logic into our reporting and measurement pipelines, enhancing efficiency and data flow.
• • Providing expert analytical support for provider performance reviews and addressing measurement inquiries will be a regular part of your responsibilities, fostering strong relationships with our provider partners.
• • Translating complex modeling outcomes into clear, actionable insights for both operational teams and executive stakeholders is paramount, enabling informed strategic decisions.
• • Ensuring the consistency and repeatability of population measurement processes across all programs and performance periods is vital for maintaining data integrity and trust.
• • You will serve as the go-to subject matter expert for population risk interpretation, providing critical support for value-based care strategy and ongoing operations.
• • This role offers a unique opportunity to influence how value-based care is measured and rewarded, directly impacting the quality of care and financial sustainability of healthcare in North Carolina.