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Risk Adjustment Associate Data Analyst (Medicare)- Hybrid
- United States
- United States
Über
This is a Monday through daylight role and will be a hybrid shift consisting of working from home and in office.
Responsibilities:
Perform analytics and reporting for Medicare Advantage and ACA risk adjustment programs.
Analyze claims and clinical data to monitor risk score performance and identify trends or issues.
Reconcile CMS MA and HHS EDGE response files; investigate and document submission discrepancies Use SQL to query, validate, and analyze healthcare data for recurring and ad hoc reporting.
Develop and maintain reports and dashboards using Power BI or similar tools.
Summarize and communicate analytical findings to business and operational stakeholders.
Collaborate with analytics, data engineering, and risk adjustment operations teams.
Document methodologies and support continuous improvement of reporting processes
Bachelors degree in a quantitative or health-related field required.
1-3 years of experience in risk adjustment reporting and analytics.
Equivalent education and experience considered.
Working knowledge of Medicare Advantage and ACA risk adjustment programs.
Understanding of CMS HCC and HHS HCC methodologies.
Experience reconciling CMS and/or HHS risk adjustment response files.
Strong SQL proficiency for healthcare data analysis.
Ability to interpret and clearly communicate analytical results.
Preferred Qualifications:
Experience with Snowflake.
Exposure to Python for analysis or automation.
Experience with Power BI or similar reporting tools.
Familiarity with claims and clinical dataLicensure, Certifications, and Clearances:
Act 34
UPMC is an Equal Opportunity Employer/Disability/Veteran
Sprachkenntnisse
- English
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