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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.
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.
- 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
- 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 understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.