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Risk Adjustment Analyst
2 months ago
We are seeking a highly skilled Risk Adjustment Analyst to join our team at MVP Health Care, Inc. As a Risk Adjustment Analyst, you will play a critical role in analyzing and reporting on Medicare, Commercial Exchange, and Medicaid/HARP member populations.
Key Responsibilities- Perform advanced analytics and reporting on large data sets to identify trends and opportunities for improvement.
- Design and implement targeting strategies to identify members with likely risk gaps across disparate data sources.
- Provide regular reporting on Risk Adjustment programs and identify opportunities and obstacles to optimize program targeting.
- Measure capture rate of Hierarchical Condition Categories (HCCs) and diagnosis codes related to Risk Adjustment programs to improve and optimize program targeting for Medicare and commercial exchange populations.
- Use Clinical Risk Group (CRG) software to target interventions for improved coding for Medicaid members.
- Calculate return on investment (ROI) for Risk Adjustment programs and maintain regulatory agency requirements for CMS and NYS related to supplemental data.
- Bachelor's Degree in Health Administration, Business, Economics, Health Informatics, or related field.
- One year of experience in a business environment involving the analysis of financial or other large data sets.
- Intermediate SQL skills and proficiency in data visualization tools such as Tableau or Power BI.
- Strong analytical and problem-solving skills, with the ability to work independently and as part of a team.
- Excellent written and verbal communication skills, with the ability to present complex data insights to stakeholders.
- Knowledge of MAO-002, MAO-004, RAPS.
- Proficiency in R or Python programming languages.
MVP Health Care, Inc. is a leading health insurance company dedicated to providing innovative solutions to improve healthcare outcomes. We are committed to creating a healthier future for everyone, and we are seeking talented individuals to join our team.
