Sr Risk Adjustment Analyst - Remote

Veradigm®; Chicago (IL); Remote; USD 80,000 - 100,000; Full time

Job summary

A leading company in healthcare analytics is seeking a Sr Risk Adjustment Analyst to leverage expertise in Medicare Advantage and ACA. The role involves developing analytics, enhancing products, and guiding customers through the Risk Adjustment process. Ideal candidates will have a strong background in healthcare data and statistical analysis, with proficiency in SAS and SQL.

Qualifications

• 3 to 5 years of experience analyzing Medicare Advantage, ACA, or Medicaid data.
• Experience supporting scalable analytic and reporting solutions.

Responsibilities

• Develop business cases and requirements for new products.
• Lead customer requests for ad hoc reporting.
• Provide training on Risk Adjustment process.

Skills

Healthcare Analytics

Statistical Analysis

Financial Modeling

Education

Bachelor's degree in Actuarial Science

Bachelor's degree in Math

Bachelor's degree in Statistics

Tools

SAS

SQL

Job description

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• Allscripts

Welcome to Veradigm, where our Mission is transforming health, insightfully. Join the Veradigm team and help solve many of today's healthcare challenges being addressed by biopharma, health plans, healthcare providers, health technology partners, and the patients they serve. At Veradigm, our primary focus is on harnessing the power of research, analytics, and artificial intelligence (AI) to develop scalable data-driven solutions that bring significant value to all healthcare stakeholders. Together, we can transform healthcare and enable smarter care for millions of people.

Job Summary

The Sr Risk Adjustment Analyst will assist our organization as a subject-matter-expert in Medicare Advantage, Affordable Care Act (ACA), Medicaid, and Accountable Care Organization (ACO) Risk Adjustment by developing requirements for new analytics and data products, creating customer financial calculations and projections, and researching customer questions regarding their risk adjustment performance.

Essential Functions

1. Develop business cases and requirements for new products and current product enhancements that will benefit our customers' risk adjustment goals, working directly with software developers to ensure their coding changes meet business requirements and expected outcomes.
2. Lead customer requests for ad hoc reporting or research.
3. Own customer financial improvement modeling (examples include: Mid-Year Payment, Final Year Payment, Transfer Payment).
4. Lead research initiatives to monitor our internal algorithm performance over time and recommend future enhancements.
5. Collaborate with clinicians in outcomes, algorithm performance, and new product development.
6. Provide training and guidance to internal and external customers on all facets of the Risk Adjustment process, from initial data capture at point-of-care, through acceptance to CMS, and successfully validated through audit.
7. Research and maintain awareness of CMS regulatory guidance and changes, providing expert interpretation for impacts to products and customers.

Job Requirements

1. Bachelor's degree in Actuarial Science, Math, Statistics, or related field.
2. 3 to 5 years of experience analyzing and interpreting Medicare Advantage, ACA, or Medicaid Risk Adjustment data and models.
3. Experience supporting the development of scalable analytic and reporting solutions.
4. Up to 10% travel may be required.

Knowledge, Skills, and Abilities

Extensive experience in the healthcare industry, with a focus on Risk Adjustment. Familiarity with MA/ACA Risk Scoring methodology, including condition categories (HCC, RxHCC, etc.). Experience with actuarial or financial modeling concepts. Experience working with large healthcare datasets, including CMS files (MMR, MOR, MAO-004, MAO-002, EDGE RARSD, EDGE RATEE, CCLF). Knowledge of clinical classification systems (ICD, HCPCS, CPT). Experience with data submission systems (RAPS, EDPS, Edge). Proficiency in SAS and SQL. Working knowledge of statistics with an interest in advancing skills. Proven technical abilities in healthcare analytics.