Expert Risk Adjustment Analyst

4 weeks ago


Raleigh, North Carolina, United States Veradigm Full time

Transforming Healthcare with Data-Driven Solutions

At Veradigm, we are dedicated to harnessing the power of research, analytics, and artificial intelligence to develop scalable data-driven solutions that bring significant value to all healthcare stakeholders.

Key Responsibilities:

  • Develop requirements for new analytics and data products to support Medicare Advantage, Affordable Care Act, Medicaid, and Accountable Care Organization Risk Adjustment.
  • Create customer financial calculations and projections to drive quality outcomes cost-effectively.
  • Research customer questions regarding their risk adjustment performance and provide expert interpretation of CMS regulatory guidance and changes.
  • Collaborate with clinicians in outcomes, algorithm performance, and new product development to deliver insights that drive quality outcomes.
  • Provide training and guidance to internal and external customers on all facets of the Risk Adjustment process.

Requirements:

  • Bachelor's degree in Actuarial Science, Math, Statistics, or a related field of study.
  • ~5 to 7 years of experience analyzing and interpreting Medicare Advantage or Affordable Care Act or Medicaid Risk Adjustment data and models.
  • Extensive experience in the healthcare industry, with a focus on Risk Adjustment.
  • Experience with MA/ACA Risk Scoring methodology, including familiarity with condition categories (HCC, RxHCC, etc.).
  • Experience with actuarial or financial modeling concepts and working with large amounts of healthcare data.

About Veradigm:

Veradigm is a dynamic, open community of solutions, external partners, and cutting-edge artificial intelligence technologies that provide advanced insights, technology, and data-driven solutions to healthcare providers, life science companies, health plans, and the patients they serve.

We offer a comprehensive compensation and benefits package, including holidays, vacation, medical, dental, and vision insurance, company-paid life insurance, and retirement savings.

Veradigm is an equal employment opportunity and affirmative action employer, committed to providing equal opportunities to all qualified individuals without regard to race, color, religion, sex, national origin, ancestry, marital status, protected veteran status, age, individuals with disabilities, sexual orientation, or gender identity or expression.



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