Clinical Risk Adjustment Analyst

Advantmed; United States; Remote; USD 80,000 - 100,000; Full time

Job summary

A leading company in healthcare analytics is seeking a skilled professional for risk adjustment analytics. Candidates should possess a strong understanding of risk models and be proficient in SQL. This role involves collaboration across teams, detailed data analysis, and communication with stakeholders to ensure data integrity and compliance.

Qualifications

• Minimum 5 years of total work experience required.
• Experience with ADHOC analysis and data visualization tools.
• Proficient in MS SQL Server platform and complex query writing.

Responsibilities

• Monitor regulatory changes and ensure products are up to date.
• Perform data analysis to ensure accuracy and compliance.
• Provide guidance to data operation department.

Skills

Data Analysis

Communication Skills

Problem-Solving

Risk Adjustment

Attention to Detail

Education

Bachelor’s degree in technology or any other relevant

Tools

MS SQL Server

Business Intelligence Tools

Job description

• What You'll Do:
• Become a resource for all data needs in Risk Adjustment Analytics.
• Monitoring regulatory changes related to risk adjustment and ensuring our products and services are up to date.
• Producing thought leadership and white papers on risk adjustment and other healthcare topics.
• Working collaboratively with cross-functional teams to ensure successful product delivery and client satisfaction.
• Perform data analysis to ensure data accuracy (business and technical compliance).
• Performing ADHOC analysis to identify and recommend process improvements and solutions for clients.
• Responsible to work with the team to stage internal/external data and present any exceptions or findings to stakeholders.
• Data Mining, Mapping, Analysis, Transforming, Cleaning, Manipulating and Reporting throughout all form of healthcare data.
• Help the team identify data trends and patterns and present findings.
• Responsible for assisting the team in producing final data mapping documentation and requirements for internal team by seeking client approval and signoff.
• Provide guidance to Data Operation Dept.
• Responsible for support and answer business questions and provide guidance to internal teams and/or customers.

What You’ll Need:

• Strong understanding of risk adjustment, including CMS-HCC and HHS-HCC models.
• Familiarity with healthcare claims data, encounters, eligibility, EHRs, and other healthcare data sources.
• Experience with ADHOC analysis, statistical analysis, and data visualization tools.
• Excellent communication, presentation, and interpersonal skills.
• Ability to work independently and collaboratively in a fast-paced, dynamic environment.
• Candidate should have experience in payer side of business also with claims data exposure
• Must have strong attention to detail, excellent oral and written skills.
• The Candidate should be able to take initiative and proactively offer suggestions and resolutions.
• The Candidate must be proficient in MS SQL Server platform, preferably in Management Studio, must have hands on experience in transforming, cleaning, and manipulating raw data and have hands on experience with Microsoft SQL including ability to write complex queries to process and view data.
• Provides timely guidance and feedback to help strengthen the knowledge/skill set of others to accomplish a task or solve a problem.
• Experience with Business Intelligence Tool will be a plus.

Bonus Points If:

• Strong problem-solving ability and tenacity to build solutions from scratch
• Flexibility to be proactive in a fast-paced & dynamic environment
• HEDIS quality analytics knowledge is preferred.

Education:

• Bachelor’s degree in technology or any other relevant

Experience

• Minimum 5 years of total work experience required