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Healthcare Risk Adjustment Analyst

Virtual Req #203
Tuesday, November 30, 2021
Episource, with over 3500 employees worldwide, is a leading provider of risk adjustment services and solutions for health plans.  Our services help Medicare Advantage, Commercial/Exchange, and Medicaid managed care plans improve and support accurate reimbursement in a post-Affordable Care Act market. Our services include retrospective chart reviews, medical record retrieval, HEDIS/ACO quality reporting, and data analytics, allowing payers and providers to dramatically reduce costs and improve quality of care.  
Healthcare Risk Adjustment Analyst


Episource leverages data to provide patient insight and drive interventions. As thought leaders and subject matter experts,we’re constantly striving to identify actionable insights. We service the $3.0 trillion healthcare space and our clients represent leading organizations throughout the United States.Episource is at the forefront of the ever-evolving healthcare marketplace. We help clients paint an accurate picture of patient healthprofiles by analyzing medical records, claims,

and clinical data sets. We’ve grown significantly to support the regulatory changesover the last 10 years, and are poised to continueour expansion as the leaderin the marketplace.


 

Position Summary:
 
 

The Healthcare Risk Adjustment Analyst will focus on managing data, creating accurate analysis, on specific schedules, utilizing the complex government run risk adjustment programs for Episource’s clients.  They will do so through research and investigation of key business problems and opportunities through quantitative analyses of claims data, membership enrollment, lab data, and pharmacy data.  Providing management with findings and conclusions.  Becoming an integral role in the development of new report offerings. 
 
 

Responsibilities:

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  • Develop procedures to load, transform, and report on structured and unstructured healthcare data.
  • Manage projects related to risk adjustment analytics and financials. 
  • Work on, and track, multiple projects with multiple clients and internal teams simultaneously. 
  • Develop intellectual capital; lead or participate in the development of tools or processes that can be leveraged for multiple clients and internal use.     
  • Present analysis and interpretation for operational and business review and planning. 
  • Through self-study, keep current on Medicare, HHS (ACA), and Medicaid risk adjustment models and consider the implications of changes to models and impact on clients and core business processes
  • Maintain subject matter expert level in risk adjustment cost, utilization, and business concepts and data
  • SQL Server and some devloper experience is a must!

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Requirements: 
 
 

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  • BA/BS degree and 5 years in healthcare industrywith an emphasis on an /Or 5+ years in healthcare industry with an emphasis on analytics·       
  • Strong analytical and mathematical skills; strong command of Excel
  • Extensive experience pulling and manipulating data from SQL servers
  • Excellent interpersonal skills; strong oral and written communication skills
  • Ability to prioritize and handle multiple tasks in demanding work environment
  • Strong critical-thinking and analytical problem-solving skills     
  • Ability to work independently and on a team

Episource, LLC provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Episource, LLC complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, placement, promotion, termination, layoff, recall, transfer, leave of absence, compensation, and training.


Episource, LLC expressly prohibits any form of unlawful employee harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Episource, LLC employees to perform their expected job duties is absolutely not tolerated.

Other details

  • Pay Type Salary
  • Job Start Date Tuesday, November 30, 2021