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Risk Adjustment Analyst
Risk Adjustment Analyst
Remote Worker - N/A • Risk
The Risk Adjustment Analyst is responsible for analyzing and reporting on data for various risk adjustment initiatives. This position manages the collection and submission of the data in order to ensure complete and accurate risk adjustment revenue through submission (Risk Adjustment Processing System - RAPS and Encounter Data Submission – EDS) and the retrospective/prospective analysis of pharmacy and claims data. The Analyst is responsible for working internally with teams and externally with providers and vendors to help ensure the program objectives are met and are in compliance with all applicable laws and regulations.
Major Work Activities
Design, produce and analyze reporting data for the various risk program initiatives in order to provide a continual assessment of performance to ensure accurate and complete risk adjustment to revenue.
Manages all collection, submission, and reconciliation requirements for Medicare Advantage, including Risk Adjustment Processing System - RAPS and Encounter Data Submission – EDS
Ensure that all submissions are completed timely and work with actuaries and vendors to estimate risk adjustment revenue.
Collaborates with Coders, Medical Directors, and Provider Liaisons to develop and implement approaches to measure the effectiveness of physician-specific initiatives for improving risk score accuracy
Maintains expert knowledge of the risk adjustment process, including regulatory changes impacting the program
Collaborates across the company and with vendors to help ensure the integration and alignment of risk adjustment strategies.
Performs other duties as assigned.
Bachelor's degree in business or health related field or equivalent work experience
5+ years demonstrated experience with Medicare Advantage risk adjustment
5+ years experience in health insurance
Experience working with vendors
Proficient in Word, Excel and PowerPoint
Required Knowledge, Skills, and Abilities
Working knowledge of Medicare Advantage and Part D laws and requirements
Strong in the following competencies: Decision Making/Judgment, Problem Solving/Analysis, Communication, Creativity/Innovation
Master's degree in business, finance, accounting, health related field, or clinical degree (RN, NP, PA, PharmD, etc.)
Experience working in regulatory agencies (CMS)
Experience leading/coordinating initiatives
Experience performing clinical data analysis
Time: Full time
Updated: 9/29/2021 2:07:01 PM