Healthcare Risk Adjustment Analyst
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Job Description
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Job Description:
We are seeking a detail-oriented and analytical Risk Adjustment Analyst to join our team. In this role, you will play a critical part in ensuring accurate and compliant risk adjustment processes that directly impact revenue optimization and regulatory reporting. You will analyze healthcare data, identify coding gaps, and support initiatives to improve risk score accuracy and data integrity.
Key Responsibilities
- Analyze claims, encounter, and clinical data to identify risk adjustment opportunities.
- Monitor and evaluate risk score trends and variances across populations.
- Collaborate with coding, clinical, and operational teams to ensure accurate documentation and coding practices.
- Develop and maintain dashboards and reports to track risk adjustment performance.
- Support audits and regulatory submissions related to risk adjustment.
- Stay current with CMS, HHS, and other regulatory guidelines affecting risk adjustment methodologies (e.g., HCC, CDPS).
- Provide insights and recommendations to improve risk adjustment strategies and outcomes.
- Work closely with vendors to assess their performance and suggest enhancements to the program as necessary.
- Perform coding quality audits on the clinics or vendors or internal staff as necessary
Qualifications
Required:
- Bachelor’s degree in Health Information Management, Public Health, Statistics, Data Science, or a related field.
- 2+ years of experience in risk adjustment analytics, preferably in a healthcare provider or insurance setting.
- Experience with Medicare Advantage, ACA, or Medicaid risk adjustment programs
- Strong knowledge of HCC coding, CMS risk adjustment models, and claims data.
- Proficiency in SQL, Excel, and data visualization tools (e.g., Tableau, Power BI).
- Excellent analytical, problem-solving, and communication skills.
Preferred:
- Certified Risk Adjustment Coder (CRC) or similar credential.
- Located in Colorado or South Texas market
Salary Range:
$52,353.60 - $69,804.80