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Healthfirst

Sr. Risk Adjustment & Coding Analyst - 100% remote

Remote

The Sr. Risk Adjustment & Coding Analyst role is responsible for analyzing, reviewing, forecasting, and trending of data to support both regulatory and internal surveillance on Risk Adjustment audit strategies. The Sr. Analyst will also support the Sr. Manager of Coding Compliance in creative strategies for effective monitoring and auditing to identify risks, reduce risk stemming from CMS RADV audits.

  • Provides analysis, extracts, and reporting of data to ensure accuracy and completeness and identify areas of risk and opportunity.
  • Serve as a resource between Risk Adjustment Team and all Operational Business Units to include Encounter Data Submissions, Finance and other departments to ensure compliance of CMS risk adjustment processes, guidelines, and company goals are met
  • Serve as the liaison between the Clinical Coding and Delivery Systems Engagement teams.
  • Present HCC performance results and findings regularly to key internal leadership.
  • Conducting analysis of coding patterns, education, and training regarding risk adjustment.
  • Supports response to Risk Adjustment Data Validation (RADV) audits by preparing analytics.
  • Assist the leadership team in building reports and dashboards to track risk adjustment related projects and track the effectiveness of the initiatives.
  • Leverages industry resources to increase knowledge of risk adjustment activities.
  • Provides guidance to junior-level analysts on data management, data analysis techniques, communication with non-technical stakeholders, project management, and healthcare industry knowledge.
  • Participates in special projects and performs other duties as assigned.
  • Conducts trend analyses to identify patterns, variations in coding practices and case-mix index, including areas of risk and comparing coding profiles with national norms.
  • Maintains statistics on coding accuracy and provides monthly summaries of coding audit results.
  • Acts as a resource on coding issues and questions to ensure accurate coding for appropriate Risk Adjustment data capture for inpatient and outpatient.
  • Demonstrates up-to-date knowledge of healthcare regulatory, coding mandates and OIG work plan.
  • Analyze audits and RA findings.
  • Maintains records of, files, education, presentations, etc. concerning all external physician audits.

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Minimum Requirements

  • High School diploma or GED.
  • Certified Coding Profession certification: CPC and CRC (If no CRC, then it must be obtained within the first year of employment)
  • Minimum 5 years of progressive healthcare industry experience in data analysis and tools.
  • Prior experience with Medicare Advantage Risk Adjustment in a Medicare, Affordable Care Act or provider organization.
  • Strong background in CPT, HCPCS, as they relate to the latest Hierarchical Condition Coding (HCC) Methodologies.
  • Demonstrated experience in collaboration, teamwork, and cross-functional communication.
  • Demonstrated ability to communicate with all levels of management with effective oral, written and interpersonal communication skills.
  • Advanced analytical problem-solving skills.
  • Advanced skills with Microsoft Office (Project, Word, Excel, PowerPoint, Outlook)Advanced proficiency in but not limited to MS Excel formulas, sorts, filters, pivot tables, IF statements, VLOOKUP, XLOOKUP, etc.),
  • Experience in critical analysis on information from multiple sources, identify issues and break down high-level information into detailed workable plan.
  • Wide degree of creativity and latitude (independent judgment) is required.
  • High level organizational and project management skills to effectively handle multiple concurrent assignments.
  • Ability to work with others and work independently.
  • Ability to multitask in a fast-paced environment required.

Preferred Requirements

  • Bachelor's Degree Preferred
  • Certified Coding Profession certification: CPMA, CDEO, CCS, CCS-P, CDIP, RHIA, RHIT

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

EEO Law Poster and Supplement

All hiring and recruitment at Healthfirst is transacted with a valid "@healthfirst.org" email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.

Hiring Range:

  • Greater New York City Area (NY, NJ, CT residents): $79,300 - $114,580
  • All Other Locations (within approved locations): $69,800 - $103,870

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

The hiring range is defined as the lowest and highest salaries that Healthfirst in "good faith" would pay to a new hire, or for a job promotion, or transfer into this role.

Job ID: healthfirst-R015894
Employment Type: Other

Perks and Benefits

  • Health and Wellness

    • Health Insurance
    • Health Reimbursement Account
    • Dental Insurance
    • Vision Insurance
    • Life Insurance
    • Short-Term Disability
    • Long-Term Disability
    • FSA
    • HSA
    • Fitness Subsidies
    • Mental Health Benefits
    • Pet Insurance
  • Parental Benefits

    • Birth Parent or Maternity Leave
    • Family Support Resources
  • Work Flexibility

    • Remote Work Opportunities
    • Hybrid Work Opportunities
  • Office Life and Perks

    • Commuter Benefits Program
    • Casual Dress
    • Happy Hours
    • Company Outings
    • Holiday Events
  • Vacation and Time Off

    • Paid Vacation
    • Paid Holidays
    • Personal/Sick Days
    • Volunteer Time Off
  • Financial and Retirement

    • 401(K) With Company Matching
    • Performance Bonus
  • Professional Development

    • Internship Program
    • Tuition Reimbursement
    • Promote From Within
    • Access to Online Courses
    • Lunch and Learns
    • Associate or Rotational Training Program
    • Learning and Development Stipend
  • Diversity and Inclusion

    • Employee Resource Groups (ERG)
    • Woman founded/led
    • Diversity, Equity, and Inclusion Program

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