| Location | New York, NY |
| Job Type | Full-time |
| Salary | $135–$150 Per Year |
Looking for a manager who can help revamp our risk adjustment reporting and develop meaningful analytics around these areas. The creation of 837 files is currently a major initiative for our team, and the role will also involve linking claims, managing adds and deletes submitted back to CMS following retrospective chart reviews, and supporting other key risk adjustment initiatives
Deep understanding of Risk Adjustment and Medicare Advantage programs.
Strong analytical and reporting capabilities, including recapture rate and RAF trend analysis.
Advanced SQL skills and experience working with large healthcare datasets.
Experience creating and managing 837 encounter files.
Knowledge of claims data, encounter submissions, and CMS reporting processes.
Experience managing retrospective chart review outcomes, including adds and deletes submitted to CMS.
Ability to transform complex data into meaningful, actionable reporting for leadership.
Strong communication skills and the ability to connect analytics to broader business and operational goals.
6-10 years in risk adjustment and/or healthcare analytics
Deep expertise in Medicare Advantage risk adjustment, HCC modeling, and CMS methodologies
Strong knowledge of value-based care contracts, policy, operations, and financial methods
Proficiency with SAS, SQL, and data mining tools