Risk Adjustment Data Analyst - CFHP

Lily Lifestyle; San Antonio, Northern (TX, KY); Hybrid; USD 65,000 - 90,000; Full time

Job summary

Community First Health Plans seeks a Risk Adjustment Data Analyst to support the risk adjustment program through data analysis, reporting, and medical record retrieval. You will partner with internal teams, provider networks, and external vendors to ensure accurate data collection and timely reporting.

You will use health informatics tools, monitor KPIs, assist with HCC capture, and ensure CMS regulatory compliance. Strong Excel skills and experience with EHR data are required.

Qualifications

• Bachelor's degree in a related field (preferred).
• At least 2 years of healthcare data analysis and medical record retrieval experience required.
• Experience in Risk Adjustment, managed care, or healthcare analytics preferred.
• Proficiency in Microsoft Excel; strong analytical and communication skills required.
• Ability to collaborate with providers, vendors, and cross-functional teams.

Responsibilities

• Analyze data and generate reports for CMS risk adjustment program.
• Coordinate with internal departments, provider networks, and external vendors.
• Monitor key performance indicators and identify trends.
• Support HCC capture and risk adjustment outcomes.
• Assist with regulatory reporting and data validation.

Skills

Analytical skills

Organizational skills

Communication skills

Microsoft Excel

EHR systems

Education

Bachelor's degree in a related field

Tools

Microsoft Excel

EHR systems

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.