Analyst, Risk Adjustment
Core
Support the day-to-day execution of Prospective Risk Adjustment programs, including Point-of-Care tools, Virtual/In-Home Assessments, and provider reporting to ensure accurate clinical documentation and claims processing.
Role type
Operational Analyst (Risk Adjustment)
Builds
Operational workflows for healthcare providers and members to capture accurate health status data
Domain
Health Insurance / Risk Adjustment / Healthcare Operations
Deliverable
dashboards & analysis
Required skills
Data analysis, reporting, data validation, reconciliation, operational workflow management, vendor coordination, claims processing
Preferred skills
SQL, Tableau, Looker, Excel, Google Sheets, knowledge of healthcare claims and provider operations
Responsibilities
Monitor program activity and workflows; coordinate with external vendors on deliverables and data exchanges; develop and maintain operational reports and trackers; support Point-of-Care tools and provider reporting initiatives; review and process member exclusions and reconcile claims
Seniority
Individual Contributor