Be an early applicantLess than 25 applicantsPosted by Agency

Company

Radiant Systems Inc · 6 hours ago

Risk Adjustment Analyst

Baton Rouge, LA

Contract

Remote

Mid Level

$40/hr - $45/hr

4+ years exp

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Hiring Manager

Vishnu vardhan Reddy (.

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Responsibilities

Conduct scientific and technical analysis to assess and improve medical diagnosis coding and documentation.

Support leadership in developing and reporting metrics to measure coding accuracy, RADV (Risk Adjustment Data Validation), and Star performance.

Provide insights and analytics on Medicare Advantage STARs and coding accuracy.

Assist management with resource allocation, decision-making, and the development of strategic plans based on data-driven insights.

Develop and apply models to identify attributes that characterize or predict coding accuracy and Star Performance.

Use reporting software and analytical models to identify opportunities for improvement in coding practices.

Perform peer reviews to validate data and processes, ensuring the accuracy, completeness, and consistency of department outputs.

Recommend process improvements as needed, and conduct descriptive and analytical studies using basic statistical techniques.

Serve as a technical expert, advising other departments on corporate and cross-functional projects, reports, and activities.

Collaborate with leadership to manage initiatives aimed at improving coding accuracy and efficiency for Risk Adjustment purposes.

Analyze and prioritize suspected conditions to guide resource allocation for Retrospective Review projects, ensuring proper follow-up and action.

Facilitate the provision of necessary data elements to support chart chase projects, ensuring comprehensive and timely data collection.

Identify trends and high-fail conditions in RADV audit submissions to improve diagnosis coding accuracy.

Quantify the impact of interventions to assess the effectiveness of existing programs and make data-driven recommendations for improvement.

Provide necessary analytics and data to support pilot programs, vendor partnerships, and departmental projects aimed at improving Risk Adjustment and coding accuracy.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Predictive modelingSASSQLRPythonTableauU.S. healthcare systemRisk adjustmentOutcome research designControlled study designEnterprise MinerProvider payment methodologiesPopulation health managementMedicare Advantage risk optimizationCommercial risk optimization

Required

A Bachelor’s degree in healthcare administration, statistics, economics, analytics, or computer science is required.

A minimum of 4 years of experience in healthcare, analytics, IT, or management consulting is required.

Strong critical thinking, analytical, and problem-solving skills are essential.

Experience in building predictive models is required.

Proficiency in analytic and visualization tools such as SQL, R, Python, and Tableau is required.

A solid understanding of the U.S. healthcare delivery system, particularly in payer and provider settings, is necessary.

Preferred

A Master’s degree in a related field is preferred.

Knowledge of outcome research design and controlled study design is preferred.

Advanced knowledge of SAS, including Enterprise Miner, is preferred.

Knowledge of provider payment methodologies, population health management, and risk adjustment is highly desired.

Familiarity with Medicare Advantage risk optimization and commercial risk optimization is a plus.

Excellent verbal and written communication skills, with the ability to communicate complex technical concepts to both technical and non-technical stakeholders, including executives, business managers, vendors, and system administrators.