Senior Risk Adjustment Specialist

Position Overview

The Senior Risk Adjustment Specialist is a critical team member in the execution of the MetroPlusHealth Risk Adjustment strategy. Your responsibilities will include management of vendors and reporting on their performance, including identifying and resolving issues. You will collaborate with internal and external partners to identify new opportunities and resolve issues as they arise. You will also use SQL and database skills to prepare reports, monitor progress, and provide ongoing and ad-hoc reports to critical partners. In addition, you will assist the Coding Quality team where needed on internal or external diagnosis coding audits. The ideal candidate will have a background in Healthcare Analytics, Health Plan Financial Reporting and / or Risk Adjustment.

Job Description

• Use SQL or another programming language to query our Enterprise Data Warehouse to prepare reports and create Key Performance Indicators (KPIs).
• Use data to measure performance of external stakeholders, communicate results and create plans to improve outcomes.
• Proactively work with external and internal partners to resolve issues – this includes identifying the root cause, devising plans to remediate, and ensuring on-time completion from all stakeholders.
• Independently manage various projects related to risk score accuracy, including supplemental chart reviews, provider outreach and member engagement.
• Work with Coding Quality team to ensure diagnosis code capture is accurate and that audits are responded to in a timely manner.
• Apply your understanding of Risk Adjustment Models and State and Federal regulatory guidelines to ensure all projects are conducted in a compliant manner.

Minimum Qualifications

Professional Competencies

Salary : $96,600