Risk Adjustment Analyst - VNS Health : Job Details

Supports initiatives that will impact the Risk Adjustment programs and operations. Collaborates with internal departments and external vendors on risk adjustment projects to meet business operational needs. Leverages industry resources to increase knowledge and improve return on investment (ROI) of risk adjustment activities. Understands risk adjustment models in emerging business areas, including but not limited to Medicaid. Becomes a subject matter expert to support business functions, operations, and systems. Manages the monthly risk adjustment meetings with key stakeholders to track the effectiveness of various initiatives critical for clinical documentation accuracy. Works under general supervision.

$93,400.00 - $116,800.00 Annual

What We Offer

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, including Medical, Dental, Vision, Life, and Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

What You Will Do

• Perform data and analytical services in support of optimizing risk-adjusted revenue, maintaining compliance with CMS standards, and modeling financial impacts of changes in risk adjustment data and methodologies. Must have strong Risk Adjustment experience/knowledge.
• Collaborate regularly with internal departments, including but not limited to Finance, Medicare Operations, Network Management, Provider Contracting, and Health Economics, and external vendors on risk adjustment projects. Calculate ROI for risk adjustment vendors, initiatives, and projects.
• Multitask and prioritize various tasks to meet deadlines. Understand various areas of the business and operational processes relevant to the project's goals.
• Leverage industry resources to increase knowledge and improve ROI of risk adjustment activities. Build understanding of risk adjustment models in emerging business areas, including Medicaid.
• Maintain current knowledge of CMS' Hierarchical Condition Categories (HCC) and Prescription Drug Risk Adjustment codes (RxHCCs), including risk adjustment values and formulas.
• Support response to Risk Adjustment Data Validation (RADV) audits by preparing analytics.
• Build reports and dashboards to track risk adjustment-related projects and track the effectiveness of the initiatives.

Qualifications

Education:

• Bachelor's Degree in Public Health or related field with equivalent knowledge required
• PMP certification preferred

Work Experience:

• Minimum two years of increasingly responsible project management or operations management experience in a healthcare setting required
• Knowledge of Medicare Advantage required
• Familiarity with medical claims and medical terminology preferred
• Proficiency in personal computer programs including MS Excel (including formulas, sorts, filters, pivot tables, IF statements, VLOOKUP, HLOOKUP, etc.), Access (criteria statements, table links, and database and report creation), and Word required
• Experience working with MS Project or other project management platform.
• Effective oral, written, and interpersonal communication skills required