• Data Scientist

    Job Locations US-RI-Smithfield
    Req No.
    NHPRI Department
    755 - Medical Expense Management
    Regular Full-Time
  • Overview

    The Data Scientist supports analytic activities for optimizing risk adjustment revenue through closing gaps in coding and care delivery across Neighborhood Health Plan of Rhode Island’s Medicare and Individual/Small Group Exchange population as prescribed by Center for Medicare and Medicaid Services, Department of Health, Health and Human Services or other State and Federal Regulatory Agencies.


    Specifically, this position is a high-level technical expert responsible for business intelligence and analytics related to Enterprise Risk Adjustment.  This position uses business intelligence, analytic, and data science techniques to improve risk adjustment results for these populations.  This includes obtaining data from various internal sources, understanding relevant differences between each data source, designing and structuring files for analysis, and performing and interpreting descriptive, bivariate, and multivariate analyses.  This position also will also be responsible for designing, conducting, and communicating analytics and research projects that support Enterprise Risk Adjustment.  This position will be expected to lead and mentor junior analysts.


    Content areas for this position will span:

    • ERA Program Analytics: Answers the question of whether we are focused on the right members, the right types of gaps in coding and care, how much we have accomplished, what opportunities remain, and estimates the value of those opportunities in order to drive risk adjustment strategy and meet our revenue targets.
    • Intervention and Pilot Test Analytics: Analytic and measurement support to inform pilot test/intervention design to ensure rigor in outcomes evaluation; evaluate pilot tests/interventions with respect to gap closure and ROI; and inform decisions about pilot/intervention modification and scale-up.
    • Provider-Focused Analytics: Analytic and reporting support to understand provider performance on gaps in coding and care delivery and enable provider coaching.

    The Data Scientist assumes a technical leadership role to analyze complex data and information to provide meaningful results, identify success factors and improvement opportunities, suggest potential solutions, and help internal customers set strategic directions.  The position should bring proven data analytics and leadership skills and a spirit of creativity and problem-solving to deepen insights into the factors that drive health care quality.  The incumbent filling this position must be highly skilled from project design through implementation and have strong communication skills and will work collaboratively in a team environment, often in leadership roles.


    • Leads the development of Risk Adjustment Program Analytics to address key strategic problems such as the accurate identification of members for gap closure and quality improvement opportunities through data analytics that will drive improved performance on risk adjustment optimization initiatives.
    • Development of Risk Adjustment Program Analytics that would help Leadership answer the question of whether we are focused on the right members, the right types of gaps in coding and care, how much we have improved the accuracy and completeness of diagnostic data, what opportunities remain, and estimate the value of those opportunities to drive risk adjustment strategy and mitigate risk.
    • Serves as a key expert on Risk Adjustment by maintaining current knowledge of the business content, regulatory knowledge, best practices, analytical methods and knowledge of diverse data sources-and systems necessary to support the efforts of Risk Adjustment analytics initiatives.
    • Effectively communicates complex Risk Adjustment concepts, strategies, initiatives, analytics, and results to a variety of stakeholders, including senior staff and leadership.
    • Reports results on risk adjustment-related outcomes, identifies needs and opportunities for improvement, and interprets results for stakeholders.
    • Provides guidance to junior-level analysts on data management, data analysis techniques, communication with non-technical stakeholders, project management, and healthcare industry knowledge.
    • Collaborates to manage, grow, and develop relationships with other analytic teams and leaders at Neighborhood Health Plan of RI, thus actively contributing to the empowering of internal analytics and the retention of talent.



    • Bachelor's degree with a quantitative emphasis, including Business, Finance, Actuarial Science, Quantitative Social Science, Mathematics, Statistics or Computer Science.
    • 7 years of progressive industry experience in data analysis and tools.
    • 2-3 years’ experience in Healthcare or Risk Adjustment Analytics analyzing and modeling data involving outcomes and utilization, using various statistical software and computer programming (SAS, SQL, R, etc.).
    • 1+ years of demonstrated experience of programming using risk adjustment models for Medicare, Medicaid and ACA Commercial, computing risk scores and evaluation of risk scores output for quality.
    • Demonstrated ability to evaluate quantitative data from multiple sources using statistical analysis and critical thinking skills.
    • Demonstrated experience with statistical software suites (e.g. SAS, R, Stata); strong understanding of database structure, relational database concepts, and exposure to Unix environments.
    • Ability to define problems, collect data, establish facts, and draw valid inferences.
    • Strong problem-solving skills exhibited by the ability to approach complex, ambiguous business issues with creative ideas and solutions.
    • Superior communication, facilitation, and presentation skills.
    • Demonstrated experience in collaboration, teamwork, and cross-functional communication.
    • Knowledge of healthcare industry including familiarity with health policy, health insurance, benefit plans and product features, provider contracting approaches, reimbursement approaches and health management approaches.
    • Flexible, self-motivated, and continuously seeking ways to improve.
    • High level organizational and project management skills in order to effectively handle multiple concurrent assignments.


    • Advanced Degree or Certifications in related field
    • Prior experience in risk adjustment activities in a Medicare, Affordable Care Act or provider organization to including submission of RAPs, and EDPS, EDGE Server files submission, responses and reconciliation per CMS and other State and Federal Guidelines.
    • Knowledge of claims coding and payment methodology, associated with a Health Plan domain.
    • Strong background in CPT, HCPCS, and related Hierarchical Condition Coding (HCC) Methodologies.

    Organizational Competencies:

    • Judgment and Decision Making
    • Gets Results
    • Collaboration and Teamwork
    • Business Awareness
    • Customer Focus

    Job Specific Competencies:

    • Attention to Detail
    • Creativity &  Innovation
    • Relationship Building & Networking
    • Continuous Quality Improvement
    • Planning & Organization

    FDR Oversight:

    • Business Lead Level:

    In the role of business lead for assigned FDR; incumbent is responsible to complete comprehensive oversight and monitoring of their vendor that incorporates the following elements: efficient and effective operations; compliance with laws, regulations, policies, procedures; and other company performance issues designed to reduce risk and add value to the company


    Flexible Work Arrangement:

    • Yes

    Telecommuting Arrangement:

    • Yes (1 day a week after 6 months of employment)

    Travel Expectations:

    • Local Business Travel


    Neighborhood is an Affirmative Action and Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status or any other legally protected basis.

    Neighborhood is committed to ensuring individuals with disabilities and/or those who have special needs participate in the workforce and are afforded equal opportunity to apply for jobs. If you would like to contact us regarding the accessibility of our Website or need assistance completing the application process, please contact us at recruiting@nhpri.org.


    Neighborhood is an EOE M/F/D/V and an E-Verify Employer



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