Risk Adjustment Analyst - Denver Health Medical Plan (*Must Be A Colorado Resident)
Risk Adjustment Analyst - Denver Health Medical Plan (*Must Be A Colorado Resident)
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$ 82400 - 127600
1 Vacancy
Job Description
We are here for lifes journey.
Where is your life journey taking you
Being the heartbeat of Denver means our heart reflects something bigger than ourselves something that connects us all:
Humanity in action Triumph in hardship Transformation in health.
Department
Managed Care Administration*Must Be A Colorado Resident
Job Summary
The Risk Adjustment Analyst will support DHMPs Medicare Advantage and ACA Marketplace lines of business. This position plays a key role in supporting risk adjustment strategy resolving EDGE submission issues coordinating with vendors and ensuring data quality and regulatory compliance.
Essential Functions:
- Develop and maintain complex SQL queries stored procedures and data models to extract and analyze claims encounter and clinical data for Medicare Advantage and ACA Marketplace populations (20%)
- Create advanced data mining algorithms and targeting models to identify risk adjustment opportunities coding gaps and high-impact member-level interventions (20%)
- Investigate and help resolve EDGE server rejections to ensure completeness and accuracy of data submissions performed by external vendors (20%)
- Prepare quarterly and annual reports for senior leadership including risk adjustment performance operational metrics and regulatory insights (20%)
- Apply deep knowledge of ACA and CMS-HCC/CMS-RxHCC risk adjustment methodologies including coefficient updates and risk score calculations (15%)
- Develop and maintain executive dashboards and reports that track KPIs such as risk score trends provider performance coding velocity and financial outcomes (5%)
Education:
- Bachelors Degree Economics Statistics Actuarial Science Public Health Mathematics or a related quantitative field required
Work Experience:
- 35 years of health insurance or healthcare analytics experience across Medicare Advantage and ACA products required and
- 2 years of direct hands-on experience with ACA and Medicare Advantage risk adjustment programs required
Licenses:
Knowledge Skills and Abilities:
- Strong data analysis skills and advanced SQL proficiency
- Experience researching and resolving EDGE submission rejections
- Strong written and verbal communication skills
Shift
Days (United States of America)Work Type
RegularSalary
$82400.00 - $127600.00 / yrBenefits
Outstanding benefits including up to 27 paid days off per year immediate retirement plan employer contribution up to 9.5% and generous medical plans
Free RTD EcoPass (public transportation)
On-site employee fitness center and wellness classes
Childcare discount programs & exclusive perks on large brands travel and more
Tuition reimbursement & assistance
Education & development opportunities including career pathways and coaching
Professional clinical advancement program & shared governance
Public Service Loan Forgiveness (PSLF) eligible employer free student loan coaching and assistance navigating the PSLF program
National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer
Our Values
Respect
Belonging
Accountability
Transparency
All job applicants for safety-sensitive positions must pass a pre-employment drug test once a conditional offer of employment has been made.
Denver Health is an integrated high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center a 555-bed acute care medical center Denvers 911 emergency medical response system 10 family health centers 19 school-based health centers Rocky Mountain Poison & Drug Safety a Public Health Institute an HMO and The Denver Health Foundation.
As Colorados primary and essential safety-net institution Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community focusing on hiring and purchasing locally as applicable serving as a pillar for community needs and caring for more than 185000 individuals and 67000 children a year.
Located near downtown Denver Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.
Denver Health is an equal opportunity employer (EOE). We value the unique ideas talents and contributions reflective of the needs of our community.
Applicants will be considered until the position is filled.
Required Experience:
IC
Employment Type
Full-Time
