Hybrid Risk Adjustment Analyst – Health Finance & Data

MetroPlus; New York (NY); Hybrid; USD 85,000 - 120,000; Full time

Job summary

MetroPlusHealth in New York City is seeking a Risk Adjustment Specialist to support data capture for high-risk populations and lead projects ensuring accurate submission to federal and state agencies. You will monitor vendor data, resolve issues, and measure performance across Medicaid, Medicare, and ACA/QHP programs.

You will analyze data from the enterprise warehouse, collaborate with internal and external partners, and apply strong analytical and financial skills, with experience in SQL, R,

Qualifications

• Bachelor's degree required, with a demonstrated interest in Finance, Social Services or Health Care.
• Minimum of 3-4 years’ experience required working for a Health Plan, or in a Finance, Project Management or Actuarial capacity in another industry.
• Ability to work independently to investigate, pinpoint, and resolve problems.
• Strong analytical and financial skills. Experience using SQL, R, SAS or another programming language is a plus.
• Proactive communication style and ability to work with a variety of stakeholders to achieve project goals.

Responsibilities

• Ongoing monitoring of data submitted by vendors to ensure project goals are being met,
• submitted data is complete and accurate, and errors are identified quickly.
• Proactively work with external and internal partners to resolve issues – this includes identifying the root cause, devising plans to remediate, and ensuring on-time completion from all stakeholders.
• Support end-to-end submission processes and encounter data across all lines of business, including Medicaid, Medicare and Affordable Care Act/QHP. This includes monitoring submission timelines, resubmissions, and validating accepted and rejected encounter metrics to ensure data is accurately reflected in downstream reporting.
• Perform financial impact analysis of Risk Adjustment activities, including implications of data errors, missed submissions, and remediation efforts.
• Access and analyze data within the enterprise data warehouse to evaluate member, provider, claims, and enrollment data in support of Risk Adjustment and encounter data initiatives.
• Utilize dashboards to identify trends and potential opportunities in data collection and reportng.

Skills

Analytical skills

Financial analysis

Independent problem solving

Communication

Education

Bachelor's degree

Tools

SQL

R

SAS

Job description

MetroPlusHealth in New York City is seeking a Risk Adjustment Specialist to support data capture for high-risk populations and lead projects ensuring accurate submission to federal and state agencies. You will monitor vendor data, resolve issues, and measure performance across Medicaid, Medicare, and ACA/QHP programs.

You will analyze data from the enterprise warehouse, collaborate with internal and external partners, and apply strong analytical and financial skills, with experience in SQL, R,