Risk Adjustment Data Analyst: HCC & RAF Insights

ArchWell Health; Nashville (TN); Sur place; USD 78 000 - 115 000; Plein temps

Résumé du poste

ArchWell Health seeks an experienced Risk Adjustment Data Analyst to support end‑to‑end risk adjustment and revenue cycle operations. You will analyze HCC submissions, manage chart-retrieval workflows, and ensure accurate ingestion of care-gap and clinical data across MA programs.

Responsibilities include validation of submissions, tracking trends, dashboard reporting, and collaboration with Operations, Coding, Clinical Documentation, vendors, and IT.

Qualifications

• Bachelor’s degree in healthcare or analytics field.
• 3–5 years of experience in risk adjustment, RCM, healthcare analytics, or payer operations.
• Strong understanding of HCC models, RAF, MAO004, 277CA/999/835 files, and encounter submission workflows.
• Proficiency with SQL, Excel, and data visualization tools (Power BI, Tableau).

Responsabilités

• Validate HCC submissions and analyze payer acceptance and rejections.
• Review sweeps and monitor ASM workflows and trends.
• Manage chart-retrieval rules and monitor turnaround times and vendor performance.
• Ingest and analyze care-gap data, ensure accurate mapping into data systems.
• Build dashboards and reports to track HCC operations and proficiency bottlenecks.
• Collaborate cross-functionally with Operations, RCM, Coding, Clinical Documentation, Vendors, and IT/Data teams.

Connaissances

SQL

Excel

Power BI

Tableau

Formation

Bachelor's degree in Healthcare Administration, Data Analytics, Public Health, or related field

Outils

VIM

HCC engine

Description du poste

ArchWell Health seeks an experienced Risk Adjustment Data Analyst to support end‑to‑end risk adjustment and revenue cycle operations. You will analyze HCC submissions, manage chart-retrieval workflows, and ensure accurate ingestion of care-gap and clinical data across MA programs.

Responsibilities include validation of submissions, tracking trends, dashboard reporting, and collaboration with Operations, Coding, Clinical Documentation, vendors, and IT.