Senior Analyst, Risk Adjustment Data Integrity & Payor Submissions
Core
Ensuring data integrity and managing complex payor submissions for the Comprehensive Health Evaluation (CHE) program within the Integrated Kidney Care Model of Care.
Role type
Senior Analyst, Risk Adjustment Data Integrity & Payor Submissions
Builds
CMS encounter data submissions and risk adjustment program performance
Domain
Healthcare / Medicare Advantage / Risk Adjustment
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure
Required skills
Advanced Excel (large datasets, complex formulas, delimited files), SQL, sFTP, EHR/Billing Systems (NextGen, Cerner, Epic), Medicare Advantage & Risk Adjustment (MRA), EDI Standards (837, 835, 999, CMS MAO-004), Data Quality & Reconciliation
Preferred skills
Medicare Advantage health plan/MSO experience, Health Information certifications (RHIA, RHIT), Business Intelligence tools (Tableau, Power BI), EHR/data platform migrations
Responsibilities
High-volume manipulation of complex data files (formatting delimiters, validating IDs and codes), managing Alternate Submission Methodology (ASM) sweeps and CMS deadlines, serving as operational link between internal teams and external payor risk adjustment teams
Seniority
Senior, hands-on IC
