Senior Risk Adjustment Analyst

Job not on LinkedIn

🕒 July 22

🐊 Florida – Remote

🐊 Florida – Remote

💵 $74.6k - $126.8k / year

⏰ Full Time

🟠 Senior

🎲 Risk

👻 Ghost score 7%

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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PacificSource Health Plans

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1933

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

PacificSource Health Plans is a healthcare provider that offers a range of health insurance solutions, including plans for individuals, families, and employers. Their offerings include Medicare and Medicaid plans, dental coverage, and administrative services for small and large groups. Committed to member care, PacificSource emphasizes customer service and provides various resources for health management, including mental health support and wellness programs.

📋 Description

• Assist in the accurate and comprehensive data submission to regulatory entities • Collaborate and coordinate with internal and external partners • Identify, analyze, interpret and communicate risk adjustment trends • Responsible for maintenance of existing reports, development of new reports • Validate data integrity and collaborate with technical teams • Develop and maintain data sets leveraging internal data • Demonstrate mastery in running all applicable risk models • Maintain strict oversight of vendor partners • Assist with all pertinent audits • Develop, maintain, and report action metrics

🎯 Requirements

• Five years’ experience in data analytics or software development required • At least three years’ experience in Health Plan required • In depth risk adjustment and/or HEDIS® experience required • Expertise in Microsoft Excel and SAS/SQL is required • Experience in leading projects and project teams required • Familiarity with Medicaid risk adjustment and CMS 5-Star required • Familiarity with Risk Adjustment Documentation, Coding practices and NCQA quality metric experience preferred • Bachelor's degree in Mathematics, Statistics, Health Informatics or similar related field required • Advanced degrees preferred

🏖️ Benefits

• Flexible telecommute policy • Medical, vision, and dental insurance • Incentive program • Paid time off and holidays • 401(k) plan • Volunteer opportunities • Tuition reimbursement and training • Life insurance • Options such as a flexible spending account