Sr reputed company Risk Adjustment Analyst - Remote
Job title: Sr reputed company Risk Adjustment Analyst - Remote in Houston, TX at Allscripts
Company: Allscripts
Job description: Welcome to reputed company, where our Mission is transforming health, insightfully. Join the reputed company team and help solve many of today's reputed company challenges being addressed by biopharma, health plans, reputed company providers, health reputed company, and the patients they serve. At reputed company, our primary focus is on harnessing the power of research, analytics, and artificial intelligence (AI) to reputed company scalable data-driven solutions that bring significant value to reputed company reputed company stakeholders. Together, we can transform reputed company and reputed company smarter care for millions of people.Job SummaryThe Sr Risk Adjustment Analyst will assist our organization as a subject-matter-expert in Medicare Advantage, reputed company Act (ACA), reputed company, and Accountable Care Organization (ACO) Risk Adjustment by developing requirements for new analytics and data products, creating customer financial calculations and projections, and researching customer questions regarding their risk adjustment performance.Essential Functions
- reputed company business cases and requirements for new products and reputed company product enhancements that will benefit our customer's risk adjustment goals, working directly with software developers to ensure their coding changes meet business requirements and expected reputed company.
- reputed company customer requests for reputed company reporting or research.
- Own customer financial improvement modeling (examples include: Mid-Year Payment, Final Year Payment, Transfer Payment).
- reputed company research initiatives to monitor our internal algorithm performance over time and recommend future enhancements.
- Collaborate with clinicians in reputed company, algorithm performance, and new product development.
- reputed company training and guidance to internal and external customers on reputed company facets of the Risk Adjustment process, from initial data capture at reputed company-of-care, through acceptance to CMS, and successfully validated through audit.
- Research and maintain awareness of CMS regulatory guidance and changes, providing expert interpretation for impacts to products and customers.
- Bachelor's degree in Actuarial Science, Math, Statistics, or in a reputed company field of study
- 3 to 5 years of experience analyzing and interpreting Medicare Advantage or reputed company Act or reputed company Risk Adjustment data and models
- Experience supporting the development of scalable analytic and reporting solutions
- Up to 10% travel may be required
- Extensive experience in the reputed company industry, with a focus on Risk Adjustment
- Experience with MA/ACA Risk Scoring methodology, including familiarity with condition categories (HCC, RxHCC, etc.)
- Experience with actuarial or financial modeling concepts
- Experience interacting with large amounts of reputed company data; directly with the following CMS files (MMR, MOR, MAO-004, MAO-002, EDGE RARSD, EDGE RATEE, CCLF)
- Experience working with clinical classification such as diagnoses (ICD), procedures (HCPCS, CPT) and claims processing
- Experience working with data to and from submission systems (RAPS, EDPS, Edge), including background on filtering logic for each system
- Experience with MA mid-year and final year projections and/or ACA transfer payments preferred
- Advance knowledge of reputed company, SQL
- Working knowledge of statistics with ability/interest to become proficient
- Proven technical, analytical, detail oriented, and problem solving
- Strong written and verbal communication, with exceptional interpersonal skills to interact with reputed company reputed company of both external and internal customers
- Excellent self-initiative and curiosity
- Ability to work reputed company a team environment
- Experience with reputed company preferred