Senior Analyst, Risk Adjustment Data Integrity & Payor Submissions

DaVita Kidney Care•09539 - Ohio Remote, OH

9d•$62,000 - $95,000•Onsite

About The Position

This Senior Analyst role would join the Integrated Kidney Care (IKC) Model of Care team working on the Comprehensive Health Evaluation (CHE) program, with a focus on encounter data submissions. By strengthening execution of complex payor submissions, improving data integrity, and performing against CMS encounter reconciliation deadlines, this person would help drive the performance of our risk adjustment programs, with an emphasis on compliance. The right candidate has experience in Alternative Submission Methodologies (ASM), CMS submission calendars, and Medicare Risk Adjustment.

Requirements

Bachelor’s degree in Healthcare Administration, Health Informatics, Data Analytics, Finance, Computer Science, Business, or a related field (or equivalent practical experience)
2–4+ years of relevant experience in healthcare data analysis, claims operations, risk adjustment, or billing/EDI operations
Advanced Excel Proficiency: High comfort manipulating large, multi-thousand-row datasets without errors (complex formulas, nested logic, text manipulation, pivot tables, and generating delimited text files such as pipe | and tilde ~).
Data Querying & SQL: Working knowledge of SQL and relational database schemas to inspect data extracts, query missing values, and validate tables against source systems.
File Transmission & Portals: Hands-on experience with secure file transfer protocols (sFTP) and secure health plan web portals.
EHR & Billing Systems: Familiarity with Electronic Health Record (EHR) and Practice Management platforms (NextGen, Cerner, or Epic).
Medicare Advantage & Risk Adjustment (MRA): Understanding of CMS Risk Adjustment concepts, Hierarchical Condition Categories (HCCs), and CMS sweeps/submission cycles
EDI Standards & Return Files: Familiarity with EDI 837 encounter files, 835 payment/remittance files, 999 acknowledgments, and CMS MAO-004 response files
Data Quality & Reconciliation: Demonstrated ability to perform root-cause analysis on claim denials, data discrepancies (e.g., mismatched subscriber IDs, invalid TINs, missing DOS), and unbilled/rebill workflows

Nice To Haves

Prior experience working within a Medicare Advantage health plan, MSO, or value-based clinical organization (e.g., IKC / ACO).
Health Information certifications (e.g., RHIA, RHIT).
Experience with business intelligence / visualization tools (Tableau, Power BI) for executive MOR and JOC reporting
Experience supporting EHR or data platform migrations

Responsibilities

High-volume manipulation of complex data files (formatting pipe \| and tilde ~ delimiters, checking Tax IDs, member identifiers, and ICD-10 codes) across various health plan templates.
Autonomously manages the recurring Alternate Submission Methodology (ASM) sweeps calendar, CMS deadline runs, and sFTP transmissions.
Serves as the primary operational link between Team Helix, Gemini /TopLine, ROPS, IT, and external payor risk adjustment teams.