ABOUT THE ROLE

The Bright Health Risk Adjustment and Coding Team is an integral component of Bright’s success as it defines and ensures outstanding clinical care for our members. The Risk Adjustment Business Analyst is responsible for all submissions and encounters business functions. This role looks end-to-end from enrollment staging, claims acquisition, clearing house, EDW landing, provision for vendor transfer, and finally to CMS response file reconciliation. This role works across departments, teams, and vendors to deliver a best in class submission accuracy across all lines of business. 

YOUR RESPONSIBILITIES

• Contribute to encounters readiness by ensuring proper setup of new products
• Assist with vendor partnership, data transfer, and ROI calculations
• Finds, communicates, and escalates root causes and ad hoc nuances
• Creates encounter related metrics for leadership teams on a cyclical basis
• Assists with, tracks, and helps implement risk adjustment related initiatives and strategies
• Seeks, maintains, and builds a best a class encounters knowledgebase
• Relentlessly champions the importance of successful encounters through the lens of payer value
• Authors and updates policies, procedures, and program guides
• Follows, reports, and adheres to all regulatory guidance

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• Bachelor's Degree required, ideally in a healthcare or technical related field
• Two (2) or more years’ experience in Medicare Advantage, Commercial, and related encounters submission management, health care, and risk adjustment required
• Three (3) or more years’ experience managing and reporting on progress of department initiatives required
• In-depth knowledge of Medicare Advantage, Commercial, and related encounters or claims lifecycle
• Proven ability to communicate Medicare Advantage, Commercial, and related encounters or claims accuracy and reconciliation
• Extensive knowledge of risk adjustment models and strategies, preferred
• Proficient in Microsoft Office Products; Word, Excel, PowerPoint, advanced proficiency preferred

PROFESSIONAL COMPETENCIES

• Strong written and verbal communication skills
• Strong attention to detail
• Ability to quickly learn and adapt to meet business needs
• Experience working with Risk Adjustment vendors
• Demonstrated knowledge of risk adjustment regulations
• Ability to work independently
• Ability to build relationships with office staff, physicians, and market team

ABOUT US

At Bright Health, we brought together the brightest minds from the health care industry and consumer technology and together we created Bright Health: a new, brighter approach to healthcare, built for individuals. Our plans are easy to manage, personalized and more affordable, giving people the quality care they deserve. Through our exclusive care partnerships with leading health systems in local communities we are reshaping how people and physicians achieve better health together.

We’re Making Healthcare Right. Together. 

We've won some fun awards like: Great Places to Work, Modern Healthcare, Forbes, etc. But more than anything, we're a group of people who are really dedicated to our mission in healthcare. Come join our growing team!

As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of Bright Health, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

BRIGHT ON!