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.
Compensation:
$93,400.00 - $116,800.00 Annual
What We Offer
- Referral bonus opportunities
- Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
- Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life Disability
- Employer-matched retirement saving funds
- Personal and financial wellness programs
- Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
- Generous tuition reimbursement for qualifying degrees
- Opportunities for professional growth and career advancement
- Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities
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
Qualifications
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
About Us
VNS Health is one of the nation’s largest nonprofit home and community-based health care organizations. Innovating in health care for more than 125 years, our commitment to health and well-being is what drives us—we help people live, age and heal where they feel most comfortable, in their own homes, connected to their family and community. On any given day, more than 10,000 VNS Health team members deliver compassionate care, unparalleled expertise and 24/7 solutions and resources to the more than 43,000 “neighbors” who look to us for care. Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions and health plans designed to simplify the health care experience and meet the diverse and complex needs of the communities and people we serve in New York and beyond.
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Mission & Values
As a team member of VNS Health, you share a passion for improving the health of patients through best-in-class care in the home and the community.
Inclusive Culture
At VNS Health, our priority is to create an environment where every team member feels they belong and are included.
Total Rewards
We provide our team members a well-rounded employment experience, competitive compensation, and a robust and affordable benefits package that serves you and your family. Our Total Rewards Program at VNS Health is an investment in your health, wealth and life.