Risk Adjustment Analyst Sr (Remote; Medicaid Encounters)

JOB SUMMARY

The Risk Adjustment Analyst Sr is responsible for monitoring and oversight of the end-to-end encounter management workflow. Supports program management activities around risk adjustment data management and submissions to government agencies such as Centers for Medicare and Medicaid Services (CMS) or Health & Human Services (HHS).

SALARY

The pay range for this position is $36.26 (entry-level qualifications) - $56.19 (highly experienced) The specific rate will depend upon the successful candidate’s specific qualifications and prior experience.

ESSENTIAL FUNCTIONS OF THE ROLE

• Performs various financial analysis such as revenue forecasting and ROI.
• Contributes to program improvement by designing and implementing business process and system changes, collaborating to resolve encounter data and process issues and managing policy and procedure documentation.
• Monitors and oversees the end-to-end claims encounter management workflow.
• Analyzes claims and supplemental data to identify reporting gaps, risk gaps, or sources of incorrect and incomplete diagnostic data.
• Researches and documents encounter errors in established systems and databases with appropriate statistical trend analysis; performs root cause analysis of encounters processing and submission issues and develops recommendations based on data and industry standards.
• Using data from internal and external sources, analyzes complex encounter inbound/outbound process issues to provide insight to decision-makers.
• Performs analysis and reporting activities related to risk score calculation, encounter data submission, chart review programs and audits, and related performance metrics per regulatory and health plan guidelines.

KEY SUCCESS FACTORS

• Performs various financial analysis such as revenue forecasting and ROI.
• Contributes to program improvement by designing and implementing business process and system changes, collaborating to resolve encounter data and process issues and managing policy and procedure documentation.
• Using data from internal and external sources, analyzes complex encounter inbound/outbound process issues to provide insight to decision-makers.
• Performs analysis and reporting activities related to risk score calculation, encounter data submission, chart review programs and audits, and related performance metrics per regulatory and health plan guidelines.
• Monitors and oversees the end-to-end claims encounter management workflow.
• Analyzes claims and supplemental data to identify reporting gaps, risk gaps, or sources of incorrect and incomplete diagnostic data.
• Researches and documents encounter errors in established systems and databases with appropriate statistical trend analysis; performs root cause analysis of encounters processing and submission issues and develops recommendations based on data and industry standards.

BENEFITS

Our competitive benefits package includes the following

• 401(k) savings plan with dollar-for-dollar match up to 5%
• Immediate eligibility for health and welfare benefits
• Tuition Reimbursement
• PTO accrual beginning Day 1

Note: Benefits may vary based upon position type and/or level

QUALIFICATIONS

• EDUCATION - Bachelor's or 4 years of work experience above the minimum qualification
• EXPERIENCE- Medicaid Encounters experience preferred; certified coder preferred
• EXPERIENCE - 3 Years of Experience