Risk Adjustment Data Analyst - CFHP

University Health; San Antonio (TX); On-site; USD 60,000 - 85,000; Full time

Job summary

University Health is seeking a Risk Adjustment Data Analyst to support the risk adjustment program through data analysis, reporting, and medical record retrieval. You will coordinate with internal departments, provider networks, and external vendors to ensure accurate collection, analysis, and CMS reporting of risk adjustment data.

A bachelor’s degree in a related field is preferred, with two years of healthcare data analysis and medical record retrieval experience.

Qualifications

• Bachelor’s degree preferred; two years of healthcare data analysis and medical record retrieval required.
• Experience with risk adjustment, managed care, or healthcare analytics is a plus.
• Proficient in Excel and able to analyze data and generate reports for CMS requirements.

Responsibilities

• Support Risk Adjustment program through data analysis, reporting, and record retrieval.
• Coordinate with internal departments, provider networks, and external vendors.
• Monitor performance and assist with regulatory reporting to ensure CMS compliance.

Skills

Analytical thinking

Communication skills

Cross-functional collaboration

Education

Bachelor's degree in related field

Tools

Microsoft Excel

Health informatics tools

Job description

POSITION SUMMARY/RESPONSIBILITIES

The Risk Adjustment Data Analyst supports Community First Health Plans' Risk Adjustment program through data analysis, reporting, medical record retrieval, and performance monitoring activities. Coordinates with internal departments, provider networks, and external vendors to ensure accurate and timely collection, analysis, and reporting of risk adjustment data. Utilize health informatics and analytics tools to identify trends, monitor key performance indicators, support Hierarchical Condition Category (HCC) capture, and improve risk adjustment outcomes. Assists with medical record retrieval initiatives, data validation, provider performance analysis, and regulatory reporting to ensure compliance with CMS requirements and organizational goals.

EDUCATION/EXPERIENCE

Bachelor’s degree in a related field preferred. Two (2) years of experience in healthcare data analysis and medical record retrieval required. Experience in Risk Adjustment, managed care, health plan operations, or healthcare analytics preferred. Knowledge of healthcare data, electronic health records (EHRs), and medical record retrieval processes preferred. Proficiency in Microsoft Excel and strong analytical, organizational, and communication skills required. Ability to work effectively with providers, vendors, and cross-functional teams.

CERTIFICATION

Coding certification within 2 years of employment (e.g., Certified Professional Coder - CPC, Certified Coding Specialist - CCS and/or data analytics certification (e.g., CHDA, Microsoft Power BI Data Analyst Associate) within two (2) years of employment, based on the requirements of their role.