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Senior Risk Adjustment Business Analyst
Posted on 1/23/2023
Experience Level
Desired Skills
  • Bachelor's degree in business or related field or equivalent combination of education and/or experience
  • Proficient in Microsoft Office Products; Word, Excel, PowerPoint
  • Knowledge of Medicare Advantage and/or commercial risk adjustment models, functions, and/or strategies
  • Two (2) or more years of experience in Medicare Advantage or Commercial risk adjustment with a health plan and/or vendor
  • Two (2) or more years of experience reporting/tracking the progress of department initiatives
  • Business analysis experience preferably in a healthcare setting
  • Intermediate proficiency in SQL, SAS, and/or other data aggregation platforms
  • Knowledge of risk adjustment encounter data lifecycle
  • Strong written and verbal communication skills
  • Strong attention to detail
  • Ability to quickly learn and adapt to meet business needs
  • Experience working with Risk Adjustment vendors
  • Effective problem solver
  • Demonstrated knowledge of risk adjustment regulations
  • Ability to work independently
  • Ability to build relationships with office staff, physicians, and market team
  • Helps lead vendor relationships and discussions as applied to contractual agreements
  • Mentor other business analysts
  • Shares Care Partner (provider) related metrics with leadership teams on a cyclical basis
  • Analyzes data to determine root cause analysis, etc
  • Finds, communicates and escalates root causes and ad hoc nuances
  • Shares risk adjustment vendor-related metrics with leadership teams on a cyclical basis
  • Tracks and helps implement risk adjustment-related initiatives and strategies
  • Seeks, maintains and builds a best-in-class vendor knowledge-base
  • Relentlessly champions the importance of successful vendor economics through the lens of a payer value
  • Authors and updates policies, procedures, and program guides, as well as executive-level presentations
  • Leads annual readiness by ensuring proper setup of new products in vendor systems
  • Follows, reports, and adheres to all regulatory guidance
  • Leads data refinements, analysis, ETL conversations, and reporting requirements discussions
  • Assists with data transfer and ROI calculations
  • The majority of work responsibilities are performed in an open office or work-from-home setting, carrying out detailed work sitting at a desk/table and working on the computer
  • Travel may be required
Bright Health

1,001-5,000 employees

Affordable personalized health insurance
Company Overview
Bright Health's mission is to make healthcare right. They believe quality health insurance should be simple, personal, and affordable. So they design easy-to-understand plans with benefits you'll actually use. Benefit-packed plans and surprisingly low rates mean you can focus on staying happy and healthy.
  • Compensation and retirement - Performance bonus, Stock Options, 401k plan, 401k matching, Commuter assistance plans
  • Health and wellness - Health insurance, Dental insurance, Vision insurance, Life insurance, Disability insurance, FSA (Flexible Spending Plan), EAP (Employee Assistance Program)
  • Vacation and time off - Unlimited time off, Paid holidays, Flexible working hours, Maternity benefits, Paternity benefits
  • Values and quality of life - Public Transportation, Bike parking, Employee groups and committees, Snacks and beverages
Company Core Values
  • Be brave - Challenge the status quo with curiosity, courage, and tenacity
  • Be brilliant - Deliver predictable excellence with a learning mindset
  • Be accountable - Live by your word, always
  • Be inclusive - Value all voices and contributions to achieve big things
  • Be collaborative - Fearlessly partner with all people