Risk Adjustment Analyst

The primary role of the Risk Adjustment Analyst (RAA) will be to function as the Claims SME for the Risk Adjustment & Analytics Department. The RAA implements data analytic reports, as well as analyzes and researches data errors and issues, collaborating with internal departments to work toward error resolution and risk outcome improvement. The RAA will own the claims adjustment workflow associated with regulatory retrospective chart review efforts. The RAA will have shared ownership within the Analytics staff for product line(s) as assigned by the Risk Adjustment Operations and Analytics Manager and will be a SME for the risk adjustment model(s) and related data submission requirements. This role will be familiar with all revenue streams relevant to the product line(s) and will develop reporting to enhance understanding of Fallon's risk scores over time and to improve revenue accuracy. The RAA will review and apply all related regulatory requirements to department activities, i.e. audits, changes in rate models, changes in submissions, etc. The RAA will be responsible for the monitoring and management of the end-to-end data follow of data submissions to vendors and government agencies to mitigate data leakage. The position will also be responsible for the direction and completion of other ad-hoc projects; including data oversight and analyses as needed. The RAA must be a team player with great problem-solving skills and the ability to prioritize deadlines as appropriate.