Risk Adjustment Analyst

• 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 and 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.
• Assists in performing analyses used in the development of financial plans, re-forecasts, and other financial projections.
• Works with product managers to provide insights into the current state of operations and identify gaps and opportunities for improvement.
• Works on identifying gaps in the claims, encounter reconciliation process, and provides insights to educate providers to improve billing practices.
• Builds reports and dashboards to track risk adjustment related projects and track the effectiveness of the initiatives.
• Tracks compliance requirements and the various business areas using reports and provides evidence of compliance, as needed.
• Interacts with business teams to gather the requirements and translate technical language. Maps documents after the necessary data analysis.
• Participates in special projects and performs other duties as assigned.