Strategic Risk Adjustment Analyst

MetroPlusHealth; New York (NY); On-site; USD 85,000 - 120,000; Full time

Job summary

MetroPlusHealth in New York City seeks a Risk Adjustment Specialist to drive data capture and accuracy across Medicaid, Medicare and QHP programs. You will monitor vendor submissions, resolve data issues, and coordinate with internal teams and external partners to meet submission deadlines.

You’ll analyze financial impacts, use enterprise data warehouses and dashboards to spot trends, and support end-to-end risk adjustment processes with a detail-oriented approach.

Qualifications

• 3–4 years’ experience in health plan or related finance/PM/actuarial field.
• Bachelor’s degree in Finance, Social Services or Health Care.
• Ability to work independently and resolve problems.

Responsibilities

• Monitor data submitted by vendors to ensure goals are met and data is accurate.
• Identify root causes and remediation plans with internal and external partners.
• Support end-to-end submission processes across Medicaid, Medicare and QHP.
• Perform financial impact analysis of Risk Adjustment activities.
• Analyze data in the enterprise data warehouse to support RA initiatives.
• Use dashboards to identify trends and opportunities in data collection and reporting.

Skills

Independent work

Problem solving

Analytical skills

Stakeholder communication

Education

Bachelor's degree

Tools

SQL

R

SAS

Job description

MetroPlusHealth in New York City seeks a Risk Adjustment Specialist to drive data capture and accuracy across Medicaid, Medicare and QHP programs. You will monitor vendor submissions, resolve data issues, and coordinate with internal teams and external partners to meet submission deadlines.

You’ll analyze financial impacts, use enterprise data warehouses and dashboards to spot trends, and support end-to-end risk adjustment processes with a detail-oriented approach.