Senior Analyst, Risk Adjustment Data Integrity – Payor Submissions

🕒 September 14

🏈 Ohio – Remote

🏈 Ohio – Remote

💵 $62k - $95k / year

⏰ Full Time

🟠 Senior

🎲 Risk

👻 Ghost score 2%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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DaVita Kidney Care

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1994

🏥 Healthcare

⚕️ Healthcare Insurance

💰 Post-IPO Debt on 2021-02

Healthcare • Healthcare Insurance

DaVita Kidney Care is a leading healthcare company that provides dialysis and related treatments for patients with kidney disease. Committed to improving the quality of life for its patients, DaVita focuses on offering integrated kidney care and supporting its diverse team of healthcare professionals, including nurses, dietitians, social workers, and patient care technicians. The company emphasizes a strong culture, career development, and comprehensive benefits to create an inclusive and supportive work environment for its employees.

📋 Description

• Join the Integrated Kidney Care Model of Care team and work on the Comprehensive Health Evaluation program • Focus on encounter data submissions and strengthen execution of complex payor submissions • Improve data integrity and perform against CMS encounter reconciliation deadlines • Manipulate high-volume complex data files across health plan templates • Format pipe- and tilde-delimited files and check Tax IDs, member identifiers, and ICD-10 codes • Autonomously manage the Alternate Submission Methodology sweeps calendar, CMS deadline runs, and sFTP transmissions • Serve as the primary operational link between Team Helix, Gemini/TopLine, ROPS, IT, and external payor risk adjustment teams

🎯 Requirements

• Bachelor’s degree in Healthcare Administration, Health Informatics, Data Analytics, Finance, Computer Science, Business, or a related field, or equivalent practical experience • 2–4+ years of relevant experience in healthcare data analysis, claims operations, risk adjustment, or billing/EDI operations • Advanced Excel proficiency, including complex formulas, nested logic, text manipulation, pivot tables, and generating pipe- and tilde-delimited text files • Working knowledge of SQL and relational database schemas • Hands-on experience with sFTP and secure health plan web portals • Familiarity with EHR and Practice Management platforms such as NextGen, Cerner, or Epic • Understanding of CMS Risk Adjustment concepts, HCCs, and CMS sweeps/submission cycles • Familiarity with EDI 837 encounter files, 835 payment/remittance files, 999 acknowledgments, and CMS MAO-004 response files • Ability to perform root-cause analysis on claim denials and data discrepancies, and manage unbilled/rebill workflows • Nice to have: experience with a Medicare Advantage health plan, MSO, or value-based clinical organization • Nice to have: RHIA or RHIT certification • Nice to have: Tableau or Power BI experience • Nice to have: experience supporting EHR or data platform migrations

🏖️ Benefits

• 401k match • Healthcare coverage • Broad range of other benefits • Equal opportunity workplace • Affirmative action protections