Risk Adjustment Analyst

Supports initiatives that will impact the Risk Adjustment programs and operations. Collaborates with internal departments and external vendors on risk adjustment projects and to meet business operational needs. Leverages industry resources to increase knowledge and improve return on investment (ROI) of risk adjustment activities. Understands risk adjustment models in emerging business areas, including but not limited to, Medicaid. Becomes a subject matter expert to support business functions, operations and systems. Manages the monthly risk adjustment meetings with key stakeholders to track the effectiveness of the various initiatives critical for clinical documentation accuracy. Works under general supervision.

$93,400.00 - $116,800.00 Annual

What We Offer

What You Will Do

• Performs data and analytical services in support of optimizing risk adjusted revenue, maintaining compliance with CMS standards and modeling financial impacts of changes in risk adjustment data and methodologies. Must have strong Risk Adjustment experience/knowledge.
• Collaborates regularly with internal departments, including but not limited to, Finance, Medicare Operations, Network Management, Provider Contracting, and Health Economics, and external vendors on risk adjustment projects. Calculates ROI for risk adjustment vendors, initiatives and projects.
• Multitasks and prioritizes various tasks to meet deadlines. Understands various areas of the business and operational processes relevant to the project’s goals.
• Leverages industry resources to increase knowledge and improve ROI of risk adjustment activities. Builds understanding of risk adjustment models in emerging business areas, including Medicaid.
• Maintains current knowledge of CMS’ Hierarchical Condition Categories (HCC) and Prescription Drug Risk Adjustment codes (RxHCCs) including risk adjustment values and formulas.
• Supports response to Risk Adjustment Data Validation (RADV) audits by preparing analytics.
• Builds reports and dashboards to track risk adjustment related projects and track the effectiveness of the initiatives.

#LI-Hybrid

Education:

• Bachelor's Degree in Public Health or related field with equivalent knowledge required
• PMP certification preferred

Work Experience:

• Minimum two years of increasingly responsible project management or operations management experience in a healthcare setting required
• Knowledge of Medicare Advantage required
• Familiarity with medical claims and medical terminology preferred
• Proficiency in personal computer programs including MS Excel (including formulas, sorts, filters, pivot tables, IF statements, VLOOKUP, HLOOKUP, etc.), Access (criteria statements, table links, and database and report creation), and Word required
• Experience working with MS project or other project management platform.
• Effective oral, written and interpersonal communication skills required