Senior Risk Adjustment Business Analyst at Bright Health
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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.
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.
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
- 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
- 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.
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.
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.