Risk Adjustment Actuary

Description

Zing Health, one of the fastest-growing Medicare Advantage plans in the country, is hiring an Actuary to support Zing’s Risk Adjustment program.

Company Overview

Zing Health is a tech-enabled insurance company making Medicare Advantage the best for those 65-and-over. Zing Health has a community-based approach that recognizes the importance of the social determinants of health in keeping individuals and communities healthy. Zing Health aims to return the physician and the member to the center of the healthcare equation. Members receive individualized assistance to make their transition to Zing Health easy. Zing Health offers members the ability to personalize their plans, access to facilities designed to help them better meet their healthcare needs, and a dedicated care team. For more information on Zing Health, visit www.myzinghealth.com.

Summary Description

The Risk Adjustment Actuary will report to the Director of Actuarial Service and will provide analytic support to departments and stakeholders through Zing. This individual contributor will be a thought leader on risk adjustment within Zing.

Essential Functions

• Being the primary risk adjustment analytics and modeling expert at Zing
• Working with Risk Adjustment Operations, Value-Based Partners, and other business stakeholders to understand risk adjustment performance and opportunities
• Tracking and reporting ROI of various Risk Adjustment initiatives
• Develop and maintain an industry-leading HCC recapture analytics and reporting suite
• Support efforts for compliant HCC suspecting
• Quantify the financial opportunities and impacts of risk adjustment activities such as Annual Wellness Visits and Chart Chase Programs.
• Own and maintain an internal Risk Score calculator using programming languages (SQL, Python)
• Own and maintain monthly risk score accrual methodology, process, and deliverables
• Stratify Zing’s membership for accurate coding initiatives
• Risk score development for Bids and Forecasting
• Maintain a culture of compliance around Medicare Risk Adjustment
  
  

Requirements

JOB REQUIREMENTS:

Required Qualifications

• ASA or FSA credentials
• 5+ years of direct Medicare Advantage work experience, ideally with significant exposure to the Medicare Risk Adjustment program
• Ability to write new and modify existing SQL and Python code
• Detailed knowledge of the CMS v24 HCC, v28 HCC, and RxHCC risk adjustment models
• High degree of attention to detail
• Ability to work effectively frequently with other departments beyond Actuarial
• High degree of independence and self-determination