Senior Risk Adjustment Analyst

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🔥 0 minutes ago

⚔️ Virginia – Remote

⚔️ Virginia – Remote

💵 $74.6k - $126.8k / year

⏰ Full Time

🟠 Senior

🎲 Risk

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PacificSource Health Plans

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1933

⚕️ Healthcare Insurance

💸 Finance

🧘 Wellness

Healthcare Insurance • Finance • Wellness

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 to minimize submission and response errors • Accumulate and report out on pertinent data sets • Develop and improve processes related to risk adjustment and quality improvement • Maintain required documentation and ensure compliance to all applicable laws, guidance, and regulations • Assume lead role on specified projects • Provide mentorship to less experienced team members • Influence decision making by leadership and provide recommendations regarding potential improvements to risk adjustment processes

🎯 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 research 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