Risk Adjustment Data Analyst

Position Summary:

The Risk Adjustment Data Analyst will support The Health Plan's risk adjustment management program with regard to risk adjustment models and guidance. This position will be involved in gathering, analyzing and reporting on data from multiple sources (e.g. member data, provider data, claims/enrollment processing, risk adjustment operations, analytical software and other resources) to extract trends and business insights to improve efficiencies and effectiveness of the risk adjustment management program.

Qualifications Required:

• College degree or a combination of education/experience in the health care industry.
• Computer experience with Microsoft Word, Excel, Power Point and Outlook
• Strong organizational, verbal and written communication skills balancing an independent and team working environment.
• Experience in data collection, analysis and visualization methods
• Previous work in a medical, managed care, or data driven organization(s).
• Ability to prioritize tasks in an environment with multiple (sometimes competing) priorities
• Experience with Microsoft SQL Server, MySQL and Power BI

Qualifications Desired:

• Proficient keyboarding skills and computer literacy with the ability to navigate through multiple systems
• Experience in a federally regulated environment
• Medical terminology
• Knowledge of ICD and CPT coding (prefer certification)
• Familiar with medical and hospital claims
• Possess a working knowledge of quality improvement principles, theory, study design and statistical modeling, forecasting and benchmarking.

Essential Functions and Responsibilities:

Develop and analyze reporting to support risk adjustment management programs/operations. Supports reporting requirements as needed for governmental and accreditation processes. Assist with submission, monitoring, and error management of encounter data to the CMS, BMS, and the EDGE server in accordance with models and guidelines. Supports reporting to identify inefficiencies to develop modifications in processes currently being used within the risk adjustment management program. Interfaces with staff and providers to support overall risk adjustment management programs with reporting. Interfacing with, gathering information from and preparing data for presentations to various levels of management, committees, internal and external partners. Utilizes databases, analytical software programs, and reporting tools to extract data, generate reports, perform moderate to complex data analysis to identify trends within a population and potential for system/process improvement. Attend continuing education classes/seminars to maintain professional and technical knowledge of State/Federal requirements.

Non-Essential Functions:

1. Perform other related duties as assigned.
2. Work hours: 8:00am - 5:00pm
3. Work hours per week: 40