Sr. Risk Adjustment Analyst

MVP Health Care • Schenectady, NY

133d • Remote

About The Position

This position involves working with the Risk Adjustment Team on both retrospective and prospective interventions. The role requires collaboration with external vendors and internal teams to maximize revenue through effective risk adjustment strategies. The candidate will be responsible for managing multiple projects, analyzing data, and providing insights to support the team's objectives.

Requirements

• Bachelor's Degree in Health Administration, Business, Economics, Health Informatics, or related field. Associate's degree with equivalent experience may also be considered.
• 3 - 5 years experience in healthcare or managed care industry required.
• Demonstrated experience managing multiple projects at once while achieving desired results required.
• Knowledge of CMS risk adjustment and reinsurance payment processes and audits for Medicare and Commercial programs required.
• Experience in risk adjustment payment models strongly preferred.
• Intermediate Microsoft Excel skills, including the ability to create simple formulas, insert rows, link data, enter and sort data and produce graphs and charts.
• Proven ability to analyze, report and provide insight on large sets of data.
• Data visualization skills (Tableau, Power BI, etc.).
• Ability to transform analytical output into simple to understand findings.
• Intermediate SQL skills.
• Possess strong analytical skills with detailed knowledge of healthcare operations and datasets.
• Curiosity to foster innovation and pave the way for growth.
• Humility to play as a team.
• Commitment to being the difference for our customers in every interaction.

Responsibilities

• Work with the Risk Adjustment Team on both retrospective and prospective interventions.
• Supply Risk Adjustment Team with retrospective chart chase lists.
• Send charts externally to vendors when necessary.
• Work through supplemental diagnosis submission process.
• Send monthly files to external vendors for their consumption.
• Work with vendors in targeting chart review and maximizing revenue.
• Provide targeting and refinement for prospective risk adjustment efforts.
• Support development and execution of a multi-year improvement strategy and annual plan of action to maximize reimbursement.
• Drive the development of targeted performance data and distribution efforts, both internally and externally to provider partners.

What This Job Offers

• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree