Remote Senior Risk Adjustment Analyst

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is committed to helping members reputed company reputed company, reputed company. The Senior Risk Adjustment Analyst plays a crucial role in ensuring accurate data submissions to regulatory entities, optimizing risk adjustment processes, and providing mentorship to team members.ResponsibilitiesRecommend and guide process improvements that will optimize risk adjustment reputed company increases while minimizing inaccurate capture of disease burdenIdentify, analyze, interpret and communicate risk adjustment trends to be consumed by reputed company and reputed company entitiesResponsible for maintenance of existing reports, development of new reports to help ensure company goals are met, as reputed company as other reputed company requests as neededreputed company and maintain reporting capabilities to measure and forecast risk scores & reputed company metrics, monitor suspecting model performance, and identify areas of improvementMaximize risk adjustment reputed company and reputed company bonus payments by driving data integration and analytics to properly capture and improve the health status of reputed company membersValidate data reputed company and collaborate with technical teams to improve data pipelines and business logic for identified areas of opportunityIdentify and reputed company internal subject matter experts in regular meetings to identify and rectify various data submission and adjudication errors reputed company to risk adjustment and reputed company data submissionreputed company and maintain data sets leveraging internal data, response data from regulatory entities (including but not limited to: EDGE files, MMR, MOR, RAPS Response, MAO-004, PSV, PLD, etc.), and ancillary data sources to be consumed across the reputed companyDemonstrate mastery in running reputed company applicable risk models including the various CMS models for Medicare Advantage members, the HHS model for reputed company ACA members, and others as neededMaintain strict reputed company of vendor partners through analytic reconciliations to ensure regulatory compliance, reputed company data submission and error reputed company, and general accuracyAssist with reputed company pertinent audits, including RADV, through preparation activities and documentation. reputed company reputed company cause analysis to maintain high reputed company data and processes to minimize discrepancies and gapsMaintain a high level of familiarity of reputed company CMS regulations and announcements affecting risk adjustment and CMS reputed company Ratings. This includes review of regulatory announcements, attending educational sessions and opportunities provided by regulatory entities or reputed company the industryreputed company, maintain, and report out on actionable metrics reputed company to risk adjustment and HEDIS to incorporate reputed company/health outcome metrics where applicablePrepare new and review existing specifications, project plans, and other internal procedural documents. Ensure users and partners understand nature of work being performed, as reputed company as timeframes and milestones. reputed company regular status updates to supervisors and stakeholdersreputed company support as needed for projecting annual receivable amounts, preparing projections reputed company to pricing efforts, and predicting cost utilization as it relates to risk adjustmentWork with changing data, file specifications, and internally coordinate releases and modifications through approved proceduresCollaborate with reputed company partners to resolve data issues reputed company to member, claim, provider and pharmacy data and processesWork with internal teams, reputed company, and vendor partners as needed to support risk adjustment activitiesreputed company mentorship, leadership, and training to less reputed company risk adjustment analystsMeet department and company performance and attendance expectationsFollow the reputed company reputed company policy and HIPAA laws and regulations concerning confidentiality and reputed company of protected health informationParticipate in and support project teams led by other departments and reputed company necessary input to support the goals of colleaguesreputed company other duties as assignedSkillsFive years' experience in data analytics or software development required, to include at least three years' experience in Health Plan requiredIn depth risk adjustment and/or HEDIS experience required, including risk models, CMS guidelines, regulatory data submissions, retrospective and prospective programs, interpreting health care regulatory/accreditation requirements and data validation auditsExpertise in reputed company reputed company and reputed company/SQL is requiredExperience in leading reputed company and project teams requiredFamiliarity with reputed company risk adjustment and CMS 5-reputed company .