Data-Driven Risk Adjustment Analyst

MetroPlusHealth; New York (NY); On-site; USD 70,000 - 100,000; Full time

Job summary

MetroPlusHealth in New York City is seeking a Risk Adjustment Specialist to support processes and lead projects to ensure data for high-risk populations is accurately captured and submitted to federal and state agencies.

You will work independently with internal partners and external vendors to monitor data submission, identify and fix errors, and track acceptance rates to drive timely, compliant reporting across Medicaid, Medicare and ACA/QHP lines.

Qualifications

• Bachelor’s degree with demonstrated interest in Finance, Social Services or Health Care.
• Minimum of 3–4 years’ experience in a Health Plan or Finance/Project Management/Actuarial role.
• Ability to work independently to investigate, pinpoint, and resolve problems.
• Strong analytical and financial skills; SQL/R/SAS knowledge is a plus.
• Proactive communication and ability to work with multiple stakeholders.

Responsibilities

• Ongoing monitoring of data submitted by vendors to ensure project goals are met.
• Submitted data is complete and accurate; errors are identified quickly.
• Proactively work with external and internal partners to resolve issues and ensure on-time completion.
• Support end-to-end submission processes across Medicaid, Medicare and ACA/QHP data and timelines.
• Perform financial impact analysis of Risk Adjustment activities and remediation efforts.
• Access and analyze data within the enterprise data warehouse to support Risk Adjustment initiatives.
• Utilize dashboards to identify trends and opportunities in data collection and reporting.

Skills

Analytical skills

SQL

R

SAS

Problem solving

Education

Bachelor's degree in Finance/Healthcare/Related field

Job description

MetroPlusHealth in New York City is seeking a Risk Adjustment Specialist to support processes and lead projects to ensure data for high-risk populations is accurately captured and submitted to federal and state agencies.

You will work independently with internal partners and external vendors to monitor data submission, identify and fix errors, and track acceptance rates to drive timely, compliant reporting across Medicaid, Medicare and ACA/QHP lines.