Senior Business Analyst - Risk Adjustment

| Remote
Apply now
By clicking continue you agree to Built In’s Privacy Policy and Terms of Use.

Back to Career Site


Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.

What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.

If you share our passion for changing healthcare so all people can live healthy, brighter lives – apply to join our team.


SCOPE OF ROLE

The Senior Risk Adjustment Business Analyst will focus on gap closure, you will be responsible for leading care gap focused discussions with internal and external teams, measuring performance against goals to acknowledge and remove barriers to success, facilitating innovative solutions to accuracy capture, and the day-to-day facilitation of our team’s relationships with Care Partners, Markets, and Clinical Teams through the risk adjustment lens. This role works across departments, teams, project development offices, and lines of business to deliver a best-in-class business results under strict regulatory adherence and compliance mindset.

ROLE RESPONSIBILITIES

  • The Senior Risk Adjustment Business Analyst job description is intended to point out major responsibilities within the role, but it is not limited to these items.
  • Owns monthly gap reporting cadence, preparation, and data summarization
  • Authors Executive level presentations and hosts monthly meetings
  • Shares Care Partner related metrics with leadership teams on a cyclical basis
  • Finds, communicates, and escalates root causes and ad hoc nuances
  • Leads data refinements, ETL conversations, and reporting requirements discussions
  • Assists with, tracks, and helps implement risk adjustment related initiatives and strategies
  • Leads annual readiness by ensuring proper setup of risk activities for new products and markets
  • Authors and updates policies, procedures, and program guides
  • Follows, reports, and adheres to all regulatory guidance 
  • Other duties and responsibilities as assigned. 
  • This position does not have supervisory responsibilities. 
  • The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer. Travel may be required. 

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

  • Bachelor's Degree required, ideally in a healthcare or technical related field
  • Three (3) years’ experience in Medicare Advantage, Commercial, and related encounters submission management, health care, and risk adjustment required
  • Five (5) years’ experience managing and reporting on progress of department initiatives required
  • In-depth knowledge of Medicare Advantage, Commercial, and related encounters or claims lifecycle required 
  • Proven ability to communicate Medicare Advantage, Commercial, and related encounters or claims accuracy and reconciliation required 
  • 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
 
We’re Making Healthcare Right. Together.
We are realizing a completely different healthcare experience where payors, providers, doctors, and patients can all feel connected, aligned and unified on the same team. By eradicating the frictions of competing needs, we are making it possible to give everyone more of what they want and deserve. We do this by:
 
Focusing on Consumers
We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
 
Building on Alignment
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.
 
Powered by Technology
We employ our purpose built, integrated data platform to connect clinical, financial, and social data, to deliver exceptional outcomes.
 
          
 
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.
 

Read Full Job Description
Apply now
By clicking continue you agree to Built In’s Privacy Policy and Terms of Use.

Technology we use

  • Engineering
  • Product
  • Sales & Marketing
    • .NETLanguages
    • C#Languages
    • JavaLanguages
    • JavascriptLanguages
    • PythonLanguages
    • ScalaLanguages
    • SqlLanguages
    • PowerShellLanguages
    • D3JSLibraries
    • ReactLibraries
    • ReduxLibraries
    • FlutterLibraries
    • ExpressFrameworks
    • Node.jsFrameworks
    • MongoDBDatabases
    • MySQLDatabases
    • PostgreSQLDatabases
    • InVisionDesign
    • SketchDesign
    • Lucid ChartDesign
    • Aha!Management
    • ConfluenceManagement
    • JIRAManagement
    • Microsoft ProjectManagement
    • Microsoft DynamicsCRM

Location

We are downtown at 515 Congress Avenue, right in the heart of downtown! Tons of restaurants and close to public transportation.
Making Healthcare Better For All At Bright Health
Watch

An Insider's view of Bright Health

What’s the vibe like in the office?

The office has a relaxed and laid back vibe but people are very serious about their work - perfect!

Anthony

Data Engineer

What does your typical day look like?

My day is so varied, given how quickly we're growing, which is fulfilling for me. I have a good balance of strategic and tactical work in my day as well as time to focus and time to collaborate.

Jen

VP, Digital

What makes someone successful on your team?

A hard-working team player who thinks first and codes next is likely to learn a lot and quickly become a valuable member of the team. Lots of experience with some of our tooling is always nice, but if someone can't knowledge-share well or responds poorly to code reviews and other requests for collaboration, it'll be a tough fit.

Brian

Software Engineer 3

How do your team's ideas influence the company's direction?

We hire smart individuals who thrive on accomplishment and purpose. Our teams are exposed to the bigger picture through constant communication and dialogues – that encourages them to come up with innovative solutions to problems. We've made significant adjustments on our direction in technology and process that were initiated by the team.

Abdullah

VP, Engineering

What are Bright Health Perks + Benefits

Bright Health Benefits Overview

We have 3 different health insurance plans, all through Cigna (HDP, Premium HDP and PPO). We cover the majority of the cost for the employee and some cost for family. We have two dental plans and a vision plan as well. We have a Lifestyle Spending Account and options for HSA/FSA. We put 3% of your total earnings into your 401K plan and you are immediately vested. We have all the latest technology (Mac or Surface laptops – your choice) to use including standing desks. Fully stocked fridge with snacks and drinks.

Culture
Friends outside of work
Eat lunch together
Daily sync
Open door policy
Team owned deliverables
Team based strategic planning
Group brainstorming sessions
Pair programming
Open office floor plan
Diversity
Dedicated Diversity/Inclusion Staff
Unconscious bias training
Someone's primary function is managing the company’s diversity and inclusion initiatives
Mean gender pay gap below 10%
Hiring Practices that Promote Diversity
Health Insurance & Wellness Benefits
Flexible Spending Account (FSA)
Bright Health employees can contribute up to $3500 annually to their FSA.
Disability Insurance
Dental Benefits
Vision Benefits
Health Insurance Benefits
Life Insurance
Wellness Programs
Bright Health is proud to offer a wellness stipend of $200/month to all employees!
Onsite Gym
Mental Health Benefits
Retirement & Stock Options Benefits
401(K)
We will put 3% of your total earnings into your 401K plan, even if you don't put anything in. It's a safe harbor contribution.
401(K) Matching
Bright Health provides employees with a 401(k) plan managed by Vanguard. We provide a ‘safe harbor’ non-elective contribution equal to 3% of your compensation, regardless of participation in the p
Performance Bonus
Child Care & Parental Leave Benefits
Generous Parental Leave
We provide up to 6 weeks of parental leave for the primary caretaker. We also provide 2 weeks of leave for the secondary caretaker.
Flexible Work Schedule
Bright Health provides employees with a flexible work schedule that includes Core hours, Flexible start and end times.
Remote Work Program
Family Medical Leave
Company sponsored family events
Bright Health sponsors family oriented events Annually.
Vacation & Time Off Benefits
Generous PTO
Paid Holidays
Paid Sick Days
Perks & Discounts
Casual Dress
Commuter Benefits
Stocked Kitchen
Happy Hours
Happy hours are hosted on occasion.
Relocation Assistance
Fitness Subsidies
Bright Health employees are eligible for discounts on several gym memberships.
Home Office Stipend for Remote Employees
Professional Development Benefits
Diversity Program
Lunch and learns
Cross functional training encouraged
Promote from within
Online course subscriptions available
Customized development tracks

Additional Perks + Benefits

Bright's primary goal is to offer employee benefits and perks that are as flexible as possible to meet each employee's unique needs!

More Jobs at Bright Health72 open jobs
All Jobs
Data + Analytics
Design + UX
Dev + Engineer
Internships
Legal
Marketing
Operations
Product
Project Mgmt
Operations
new
Remote
Data + Analytics
new
Austin
Developer
new
Austin
Operations
new
Remote
Data + Analytics
new
Remote
Developer
new
Austin
Developer
new
Austin
Developer
new
Remote
Project Mgmt
new
Remote
Data + Analytics
new
Austin
Operations
new
Remote
Developer
new
Remote
Data + Analytics
new
Remote
Data + Analytics
new
Remote
Operations
new
Remote
Operations
new
Austin
Project Mgmt
new
Austin
Data + Analytics
new
Austin
Operations
new
Remote
Marketing
new
Remote
Marketing
new
Remote
Developer
new
Remote
Product
new
Remote
Data + Analytics
new
Remote
Operations
new
Remote
Operations
new
Remote
Developer
new
Remote
Data + Analytics
new
Remote
Developer
new
Austin
Operations
new
Remote
Design + UX
new
Austin
Data + Analytics
new
Remote
Developer
new
Austin
Project Mgmt
new
Austin
Operations
new
Remote
Operations
new
Remote
Data + Analytics
new
Remote
Data + Analytics
new
Remote
Developer
new
Remote
Developer
new
Austin
Data + Analytics
new
Remote
Project Mgmt
new
Remote
Data + Analytics
new
Remote
Operations
new
Remote
Operations
new
Remote
Operations
new
Remote
Data + Analytics
new
Remote
Data + Analytics
new
Austin
Apply now
By clicking continue you agree to Built In’s Privacy Policy and Terms of Use.
Save jobView Bright Health's full profileSee more Bright Health jobs