Risk Adjustment Analyst Part-Time

HealthOne Alliance-posted about 1 month ago
Part-time • Entry Level
Dalton, GA
11-50 employees
Resume
Match Score
Upload and Match ResumeTrack Jobs with Teal

The 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.

  • 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.
  • Bachelor’s Degree in Statistics, Accounting, Mathematics, Computer Science, Business, or related field
  • One to three years’ health plan experience preferred
  • Understanding of statistical methods, with programming experience in R or SAS preferred
  • Intermediate to Advanced proficiency with SQL
  • Familiarity with insurance terms and concepts
  • Advanced Microsoft Excel skills
  • Excellent communication skills
Track Jobs with Teal

Job Search Resources

•
Resume Builder
•
Risk Analyst Resume Examples
•
Risk Analyst Cover Letter Examples

Tools

Career Hubs

Guides

Company

© 2024 Teal Labs, Inc
Privacy PolicyTerms of Service