Risk Adjustment Analyst Part-Time

MISSION Our mission is to enhance well-being by connecting individuals with vital health resources through a compassionate workforce that embodies the spirit of neighbors helping neighbors.

VALUES HealthOne is guided by a cultural framework that embodies our values and drives our decisions. 

Our PURPOSE is to care for people by connecting them to resources that help protect them in health-related situations. To fulfill our purpose, we align our PRIORITIES to ensure each decision we make is ethical, empathetic, economical, and efficient. We care for PEOPLE by being welcoming, authentic, truthful, consistent and humble. We are continuously looking for ways to improve our PROCESS and how we get things done.

HealthOne seeks individuals with integrity and heart to embody our values. Whether you’re starting your career or looking to develop additional skills to reach your full potential, HealthOne provides the means to help you achieve your goals.

JOB PURPOSEThe Risk Adjustment Analyst supports the analysis and reporting of clinical, strategic, and financial data to help ensure risk scores and related revenue align with the health status of insured members. This role involves assisting with data analysis and reporting, learning and applying basic statistical techniques, and supporting the team in identifying trends and patterns related to risk adjustment. This incumbent works closely with senior team members to help maintain data accuracy, support data submissions, and contribute to the calculation and monitoring of key performance metrics.

ESSENTIAL JOB DUTIES

    Assists in preparing encounter, enrollment, and supplemental data for submission to the EDGE server in accordance with CMS requirements, under the guidance of senior team members. Reviews response files and helps identify and correct submission errors.Supports the maintenance and updates of databases and dashboards related to Risk Adjustment key performance indicators (KPIs), helping track data on a monthly, quarterly, and annual basis.

    Collaborates with internal departments such as Finance, Government Programs, Network Management, Provider Contracting, and Analytics, as well as external vendors, to assist on risk adjustment-related projects.Assists in gathering data and supporting calculations used to assess ROI for risk adjustment vendors, initiatives, and projects.

    Helps identify potential coding gaps in claims, pharmacy data, and encounter reconciliation processes by writing or reviewing basic SQL queries with guidance from more experienced analysts.Supports data collection and reporting efforts related to RADV (Risk Adjustment Data Validation) audits.

    Learns and maintains an understanding of CMS’ Hierarchical Condition Categories (HCC) and Prescription Drug Risk Adjustment codes (RxHCCs), including how risk scores are calculated.Aids in understanding and applying EDGE Server business rules and regulatory requirements by reviewing documentation and supporting compliance efforts.

    Contributes to the development of reports and data summaries used to support risk adjustment activities, under supervision.Assists in preparing and maintaining monthly, quarterly, and annual risk adjustment reports for internal stakeholders and regulatory compliance.

    Participates in identifying data errors and helps coordinate resolutions with relevant teams such as claims, enrollment, and pharmacy.Supports root cause analysis of emerging issues by gathering and organizing data, and participating in discussions with senior analysts to identify solutions.

    Maintains regular and predictable attendance.Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practice.

    Works to encourage and promote Company culture throughout the organization.Other duties may be assigned.QUALIFICATIONS

    Bachelor’s Degree in Statistics, Accounting, Mathematics, Computer Science, Business, or related fieldOne to three years’ health plan experience preferred

    Understanding of statistical methods, with programming experience in R or SAS preferredIntermediate to Advanced proficiency with SQL

    Familiarity with insurance terms and conceptsAdvanced Microsoft Excel skillsExcellent communication skills

PHYSICAL REQUIREMENTSProlonged periods of sitting at a desk and working on a computer. Moderate to significant amount of stress in meeting deadlines and dealing with day-to-day responsibilities. Must be able to drive a vehicle and daytime/overnight travel as required.

PRE-EMPLOYMENT SCREENINGDrug Screen and Background Check Required

HEALTHONE IS AN EQUAL OPPORTUNITY EMPLOYERAll qualified applicants will receive consideration for employment without regard to race, color, creed, religion, disability, sex, age, ethnic or national origin, marital status, sexual orientation, gender identity or presentation, pregnancy, genetics, veteran status or any other status protected by state or federal law.