Disease Burden (HCC) Business Intelligence Developer

We are seeking a highly analytical and detail-oriented Risk Adjustment Reporting Developer to support our organization’s Medicare Advantage, ACO, ACA, and other risk-based programs. This role is critical in reporting, trend analysis, RAF analytics, and provider opportunity targeting. The ideal candidate understands CMS risk-adjustment methodologies, coding impacts, and can turn data insights into actionable strategies for providers, CDI, and clinical teams.

Job Summary

Partners with the business to turn data into critical information and knowledge. Possesses a fundamental understanding of healthcare and/or data and analytics. Develops reporting and analytic solutions with knowledge of the primary source data (i.e., electronic health record, claims) and workflows. Develops relationships with users for direct consumption or integration with other systems. BI Developers promote data literacy by educating and training customers to use the data as an analytical tool, displaying the information for the purpose of analysis and exploration. Under minimal supervision, designs, codes, configures, tests, debugs, deploys, documents, and maintains programs. Uses a variety of software development tools, programming languages and testing/verification applications. Their work adheres to development best practices and quality standards. Gathers business requirements and translates the information into detailed technical specifications from which programs will be written or configured, and to validate that the proposed applications align with both the architectural design and business needs. Works closely with other BIDs, Data Engineers, Data Scientists, and internal/external customers.

Essential Functions

• Risk Adjustment Analytics & Reporting
  • Develop and deliver recurring and ad-hoc reports on RAF trends, HCC capture rates, provider performance, and suspect lists.
  • Analyze large datasets (claims, EHR, encounter files) to identify gaps and missed opportunities.
  • Monitor RAF impacts, HCC prevalence, V28 mapping changes, and quality indicators.
  • Build dashboards and visualizations using Epic, Power BI, Tableau, or similar tools.
  • Provide actionable insights to support coding, CDI, and provider education.
• Provider Targeting & Opportunity Identification
  • Create provider-level opportunity lists for chronic conditions, recapture needs, and care gaps.
  • Collaborate with CDI, coding, and provider relations teams to prioritize outreach strategies.
  • Analyze documentation trends and recommend workflow improvements.
• Trend Monitoring & Forecasting
  • Conduct year-over-year HCC trend reviews and measure program effectiveness.

Qualifications

Required

• Bachelor's Degree or equivalent in business, liberal arts, computer science, application programming, software development, information systems, database administration, mathematics, engineering, or related field
• 2 years of relevant experience
• EPIC Cogito Certification held within 6 months of hire

Preferred

• Prior work in payer, ACO, MSO, or risk-bearing provider group.
• Experience in risk adjustment analytics, RAF modeling, or healthcare data analysis.
• Strong understanding of ICD-10-CM, HCC coding, V28 models, and risk-adjustment methodologies.
• Ability to analyze complex datasets and present actionable insights.
• Excellent communication skills for non-technical audiences.
• Epic Certifications in Cogito, Clarity and Caboodle held upon hire

About Corewell Health

As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

How Corewell Health cares for you

• Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.

• On-demand pay program powered by Payactiv

• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!

• Optional identity theft protection, home and auto insurance, pet insurance

• Traditional and Roth retirement options with service contribution and match savings

• Eligibility for benefits is determined by employment type and status

Primary Location

SITE - Corewell Health Place - 100 Corewell Drive NW - Grand Rapids

Department Name

QSE Pop Health Disease Burden - Corporate

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

40

Hours of Work

8:00 a.m. to 5:00 p.m.

Days Worked

Monday to Friday

Weekend Frequency

N/A

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Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.