Risk Adjustment Business Analyst I

AmeriHealth Caritas is a mission-driven organization with over 30 years of experience in health care solutions. The Risk Adjustment Business Analyst I will manage risk adjustment activities, develop relationships with stakeholders, and analyze performance metrics to support the program's success.

Responsibilities:

• Develop a strong relationship with key risk adjustment stakeholders (e.g., Provider Network Management Account Executives, Quality and HEDIS leaders, etc.)
• Facilitate review and approval of program collaterals/communications for both implementation of new program components or to support ongoing needs of the program
• Generate and monitor meaningful performance and financial metrics to evaluate performance of each line of business. Report timely and accurate information to management through standardized dashboards and reports. Broadcast results of reporting to stakeholders and ensure that any data anomalies or areas of concern are called to audience
• Provide administrative support to coordinate and sometimes lead needed work sessions/projects with cross organization teams to implement new program components, perform preliminary root cause analysis and suggest resolution to correct issues
• Serve as a POC for provider portal(s) and other vendor applications used that support the risk adjustment program
• Track, research and resolve issues reported to risk adjustment from a myriad of sources (e.g., providers, Account Executives, leadership, etc.). Escalate issues to management for assistance in resolution. Progress and resolution communicated frequently with stake holders
• Complete assigned analysis of data to identify areas for targeted campaigns to increase chronic diagnosis capture
• Participates in goal and target planning activities within the department
• Work to develop business knowledge, analytical skills and basic technical abilities
• The Risk Adjustment Business Analyst I will develop knowledge to support all assigned markets, vendor activities, risk adjustment models (e.g., HCC, CDPS+RX, ACG, etc.) and concepts, as well as other health insurance data sets available to support the program

Requirements:

• Associate's Degree
• Solid knowledge of Health Insurance, Claims Data, Manage Care, Medicare and/or Medicare plans
• 1 to 2 years of analytic experience or equivalent education/experience in Healthcare, Medicaid, Medicare or Risk Adjustment
• Solid knowledge of MS Office Suite with demonstrated knowledge of MS Access and Excel
• Knowledge of SQL, Hadoop and/or Tableau is a plus