Risk Adjustment Analyst I

• Analyze risk adjustment and claims data to identify trends, data gaps, and improvement opportunities.
• Support the design and implementation of risk adjustment strategies across Medicare, Medicaid, Exchange, and Commercial lines of business.
• Assist with internal and external audits, including RADV (Risk Adjustment Data Validation), by preparing supporting data and documentation.
• Perform data quality checks and reconciliation of CMS file rejections, EDPS, RAPS, and 3M reports.
• Partner with vendors to track and support chart retrieval, data validation, and documentation improvement efforts.
• Collaborate with coding teams to ensure accurate and complete documentation for risk adjustment purposes.
• Develop and maintain dashboards, reports, and project trackers to support operational transparency and performance monitoring.
• Assist in the development and maintenance of internal policies and procedures aligned with CMS and state risk adjustment regulations.
• Communicate project status and insights through presentations, data summaries, and regular reporting.
• Participate in cross-functional workgroups focused on claims processing, provider education, and data submissions.
• Support provider engagement and training efforts by preparing materials and organizing sessions that promote accurate documentation and coding practices.
• Stay current on regulatory changes and support the implementation of compliance updates as needed.
• Lead or support operational projects related to chart reviews, risk score accuracy, encounter submissions, and vendor performance.

• Proficiency in SQL is required, including the ability to query, validate, and analyze healthcare data to support risk adjustment operations and reporting.
• Strong analytical and problem-solving skills with the ability to interpret healthcare data and draw actionable insights.
• Familiarity with Medicare Advantage risk adjustment, Medicaid risk adjustment, or ACA preferred
• Familiarity with key CMS and NYSDOH reports, including:
  • Monthly Membership Report (MMR), Medicare Operations Report (MOR)
  • RAPS Returns, EDPS reports, Plan payment reports
  • 3M Medicaid reporting and associated metrics

• Excellent organizational skills with the ability to manage multiple projects and timelines.
• Effective written and verbal communication skills; ability to translate complex concepts to non-technical stakeholders.
• Proficient in Microsoft Office (Excel, Word, PowerPoint); experience with data tools (Python, Tableau, SAS, or similar) is a plus.
• Strong attention to detail and commitment to data integrity and compliance.
• Comfortable collaborating across departments and engaging with external stakeholders including vendors, payers, and provider groups.
• Ability to work both independently and in a team-oriented environment.

• Bachelor’s degree in public health, healthcare administration, business, data analytics, or a related field preferred; high school diploma or equivalent required.
• Entry-level candidates with a strong educational background will be considered.

• 1–3 years of experience in a healthcare setting, preferably in risk adjustment, medical coding, health plan operations, or data analytics.
• Exposure to managed care, CMS audits, or healthcare data submission processes is a plus.
• Familiarity with CMS audit processes and RADV audit procedures preferred.

🔗 Our website: HealthCare Partners
💵 Base Compensation: $65,000.00- $75,000.00 annually
Bonus Incentive: Up to 12.5% annually based on organizational performance
💼 Benefits: Fully paid Medical & Dental employee coverage + robust benefits package (PTO, 401k, FSA, Tuition Reimbursement, etc.)

Equal Employment Opportunity Statement:
HealthCare Partners, MSO is committed to fostering a diverse and inclusive workplace. We provide equal employment opportunities (EEO) to all employees and applicants without regard to race, color, religion, sex, national origin, age, disability, genetics, or any other protected status under federal, state, or local laws. In compliance with all applicable laws, HealthCare Partners, MSO upholds a strict non-discrimination policy in every location where we operate. This policy applies to all aspects of employment, including but not limited to recruitment, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Job Disclaimer:
The above job description outlines the general scope and responsibilities of the position. It is not intended to be an exhaustive list of duties, skills, or qualifications required. Responsibilities may evolve based on business needs.

Department: Quality
This is a non-management position
This is a full time position