Senior Risk Adjustment Informatics & Workflow Analyst

Banner Health•Phoenix, AZ

1d•Remote

About The Position

As a Senior Risk Adjustment Informatics & Workflow Analyst, you will design and maintain workflows that support Banner’s risk adjustment programs across EHRs, Innovaccer, PowerApps, and related systems. You will translate HCC coding, clinical documentation standards, and CMS requirements into clear, compliant, and scalable processes. Your day-to-day work will include troubleshooting technical issues, debugging data flows, and partnering with IT and analytics to improve system performance. You will collaborate closely with coding, provider education, QA/RADV, compliance, and network teams to ensure documentation is audit‑ready and defensible. The role supports prospective, concurrent, and retrospective risk adjustment initiatives through strong workflow design and hands-on system expertise. This is a remote opportunity for Senior Risk Adjustment Informatics & Workflow Analyst. The schedule will be Monday-Friday 8 hour shifts. Banner Plans & Networks (BPN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BPN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs. POSITION SUMMARY This position designs, implements and maintains risk adjustment informatics and workflow infrastructure supporting Banner Plans & Networks enterprise risk adjustment programs. The role focuses on translating clinical documentation, coding guidance and regulatory requirements into standardized workflows across Cerner, community EHRs, Innovaccer, PowerApps and supporting coding systems. Partners with Coding Operations, Provider Education, QA/RADV, IT, Analytics, Compliance and Network leadership to ensure risk adjustment workflows are scalable, measurable, compliant and operationally effective. This role supports prospective, concurrent and retrospective risk adjustment initiatives across Banner's network and ensures operational processes meet CMS and Banner compliance standards.

Requirements

Bachelor’s Degree in a relevant field.
Five plus years of relevant experience in designated facility, business entity or area, including experience within a major health care organization, health system setting, or large multi-operational corporate environment in complex industries similar to healthcare.
Extensive experience in risk adjustment coding operations, provider education, and technology-enabled coding solutions, with a strong background in managed care, value-based care, and regulatory compliance.
National coding certification from AAPC or AHIMA to include one or more of the following: Certified Professional Coder (CPC), Certified Coding Specialist-Physician (CCS P), Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), and/or one of the sub coding certifications with respect to HCC/RAF.

Nice To Haves

Additional related education and/or experience preferred.

Responsibilities

Designs and maintains standardized risk adjustment workflows in collaboration with teams that align with CMS regulations, OIG guidance, Banner compliance policies and coding program requirements.
Translates regulatory guidance, coding standards, and documentation requirement into operational workflows across BPN systems.
Ensures workflows produce complete, traceable documentation supporting audit defensibility and appropriate coding practices.
Maintains workflow documentation, SOPs and process controls supporting compliance and internal audit readiness.
Partners with QA/RADV leadership to ensure operational workflows generate defensible documentation and appropriate audit trails.
Identifies workflow gaps that may create compliance or RADV risk and works with Coding Operations and IT to remediate processes.
Supports development of documentation standards that reduce coding variance across providers and clinics.
Assists in preparing workflow documentation, process maps and system logic supporting internal and external audits.
Builds and maintains operational data capture workflows that ensure consistent, accurate and compliant documentation for risk adjustment programs.
Designs system workflows that allow downstream analytics teams to reliably report performance metrics and program outcomes.
Develops and maintains standardized operational data extracts supporting provider huddles, concurrent coding programs and documentation review sessions.
Works with Coding Operations and Medical Directors to ensure huddle data reflects compliant documentation and coding guidance.
Build repeatable workflows that allow accurate patient lists, suspect condition identification and documentation tracking for clinic use.
Ensures huddle data is sourced and prepared in compliance with Banner policies and CMS guidance.
Partners with IT and Analytics teams to design and test workflows across applications, inclusive of Innovaccer, PowerApps and EHRs.
Supports requirements gathering, UAT testing and workflow validation to ensure compliance and usability.
Identifies workflow automation opportunities that reduce manual processes while maintaining compliance standards.
Collaborates with Coding Operations, Provide Education QA/RADV, Compliance, Analytics, Plan and Network leadership to ensure workflows align with regulatory requirements and operational needs.
Serves as liaison between operational teams, IT and analytics partners to maintain compliant system and process functionality.
Supports consistent communication of workflow standards across Banner network providers.
Monitors workflow adoption, documentation completeness and process consistency.
Identifies process risks and recommends improvements to support compliance and audit readiness.
Supports coding, nursing and provider education teams in implementing updated workflows.
Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards.
Provides all customers of Banner Health with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.