Strategic Risk Adjustment Analyst - Data & Insights

St. Luke's Health System; Boise (ID); On-site; USD 75,000 - 110,000; Full time

Benefits offered by this job

On-site massages

On-site counseling via EAP

Wellness tool access

Career development and formal training

Job summary

St. Luke’s Health System in Boise, ID, seeks a Risk Adjustment Analyst to partner with business segments and lead risk adjustment data analysis for QHP/ACA and Medicare Advantage programs.

You will develop processes, deliver insights, and collaborate with cross-functional stakeholders to improve health plan outcomes. The role emphasizes interpretation of claims data, regulatory knowledge, and data governance, with opportunities to drive operational planning and decision making in a dynamic

Qualifications

• Education: Bachelor’s degree or experience in lieu of degree.
• Experience: Six (6) years' relevant experience.

Responsibilities

• Analyzes and interprets health insurance data to identify operational issues and support decision making.
• Translates technical, clinical, financial and operational problems into actionable analyses.
• Collaborates with internal Data & Analytics and external vendors to define data requirements and ensure data integrity.
• Leads special projects and participates in cross-functional teams as needed.
• Ensures data governance and data quality standards are applied to analytics.

Skills

SQL

QHP/ACA Risk Adjustment

Medicare Advantage Risk Adjustment

HEDIS/Stars knowledge

Education

Bachelor’s degree or experience in lieu of degree

Tools

EDGE Server Data Submission

Job description

St. Luke’s Health System in Boise, ID, seeks a Risk Adjustment Analyst to partner with business segments and lead risk adjustment data analysis for QHP/ACA and Medicare Advantage programs.

You will develop processes, deliver insights, and collaborate with cross-functional stakeholders to improve health plan outcomes. The role emphasizes interpretation of claims data, regulatory knowledge, and data governance, with opportunities to drive operational planning and decision making in a dynamic