Analyst Risk Adjustment II
HealthNow New York Inc. - Buffalo, NY

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Position Summary: The Analyst, Risk Adjustment II is responsible for key activities that result in revenue optimization and better identification of members that might benefit from case or disease management.

Primary Job Duties:
  • Analyzes member data on reports to identify members who require review
  • Develops tools, models and algorithms geared toward the identification of projects to ensure HCC information is accurate, comprehensive, and properly prioritized
  • Implements projects to ensure HCC information is accurate, comprehensive and properly prioritized
  • Demonstrates analytical problem solving skills related to review and validation to ensure accurate information is obtained
  • Monitors risk scores and reports on trends and causes of change
  • Supports and participates in process improvement initiatives
  • Identifies members with high risk HCC conditions and refers members to case and disease management for follow up care or interventions
  • Identifies trends within the provider network related to inaccurate coding and targets those that would benefit from educational training
  • Contributes to the development and maintenance of documents and materials related to the RAPT
  • Colllaborates with internal staff for information sharing and performs other related duties, including special projects as assigned by manager
Required Skills Primary Skills/Knowledge:
  • Knowledge of data collection and analysis
  • Excellent analytical and problem solving skills
  • Ability to adjust to multiple demands and shifting priorities
  • Ability to function independently with excellent judgment and ability to identify and address issues with the most advantageous cost/benefit outcomes
  • Microsoft Office, Facets, SQL
Required Experience Preferred Education:
  • Bachelors Degree in business-related field required
  • Masters Degree preferred
Preferred Experience:
  • Three (3) years experience in analytics and data analysis, including two (2) years in healthcare required

HealthNow New York Inc. - 17 months ago - save job - block
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