Risk Adjustment Analyst

Overview

Supports initiatives that will impact the Risk Adjustment programs and operations. Collaborates with internal departments and external vendors on risk adjustment projects and 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 the various initiatives critical for clinical documentation accuracy. Works under general supervision.

What We Provide

• 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, 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

• Performs 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.
• Collaborates 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. Calculates ROI for risk adjustment vendors, initiatives and projects.
• Multitasks and prioritizes various tasks to meet deadlines. Understands various areas of the business and operational processes relevant to the project's goals.
• Leverages industry resources to increase knowledge and improve ROI of risk adjustment activities. Builds understanding of risk adjustment models in emerging business areas, including Medicaid.
• Maintains current knowledge of CMS' Hierarchical Condition Categories (HCC) and Prescription Drug Risk Adjustment codes (RxHCCs) including risk adjustment values and formulas.
• Supports response to Risk Adjustment Data Validation (RADV) audits by preparing analytics.
• Assists in performing analyses used in the development of financial plans, re-forecasts, and other financial projections.
• Works with product managers to provide insights into the current state of operations and identify gaps and opportunities for improvement.
• Works on identifying gaps in the claims, encounter reconciliation process, and provides insights to educate providers to improve billing practices.
• Builds reports and dashboards to track risk adjustment related projects and track the effectiveness of the initiatives.
• Tracks compliance requirements and the various business areas using reports and provides evidence of compliance, as needed.
• Interacts with business teams to gather the requirements and translate technical language. Maps documents after the necessary data analysis.
• Participates in special projects and performs other duties as assigned.

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

Pay Range

USD $93,400.00 - USD $116,800.00 /Yr.

About Us

VNS Health has been committed to meeting the needs of New Yorkers for over 130 years. We're one of the largest nonprofit home- and community-based health care organizations in the country, and today, more than 11,500 team members work together to make a difference in the lives of more than 99,000 patients and members on any given day.