SCOPE OF ROLE

The Bright Health Risk Adjustment Team is an integral component of Bright’s success as it defines and ensures outstanding clinical care for our members. The Senior Risk Adjustment Business Analyst is responsible for program execution, data analytics and reporting.  This role supports the execution of prospective and retrospective programs to ensure complete data capture of members’ diagnoses.  This role works across departments, teams, and vendors to deliver a best in class processes and analytics for our Medicare business.

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.

• Generates monthly reporting package noting Key Performance Indicators as well as ad hoc analytics
• Authors and updates policies, procedures and program guides
• Assists with, tracks and helps implement risk adjustment related initiatives and strategies
• Authors executive level presentations and hosts monthly meetings
• Other duties and responsibilities as assigned

SUPERVISORY RESPONSIBILITIES

• This position will not have supervisory responsibilities.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• Bachelor's Degree required, ideally in a healthcare or technical related field
• Three (3) or more years’ experience in Medicare Advantage and risk adjustment data analytics, including the use of databases, required
• Five (5) or more years’ experience managing risk adjustment projects/programs
• In-depth knowledge of Medicare Advantage and related encounters or claims lifecycle
• Proven ability to communicate Medicare Advantage 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

LICENSURES AND CERTIFICATIONS

• No licensures and/or certifications are required for this role.

WORK ENVIRONMENT

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. This position may also be work from home.  Travel may be required.