Enterprise Risk Adjustment Analyst
The Judge Group Inc.

Location: REMOTE
Salary: $60.00 USD Hourly - $70.00 USD Hourly
Description:
Job Title: Enterprise Risk Adjustment Analyst

Contract Duration: 3 months (Potential for extension or permanent conversion)

Location: Fully Remote

Key Responsibilities:

• Create and manage data extracts and perform Encounter Data submissions for Medicare, Medicaid, and ACA Commercial programs.
• Review submission reports and reconcile internal data with data submitted to CMS/DHS/CMS-HHS.
• Measure the accuracy and effectiveness of current data submission processes.
• Develop recommendations to solve complex problems related to Encounter Data Submissions operations.
• Perform root cause analysis to address potential gaps in risk scores.
• Research, analyze, and interpret Encounter Data, providing technical assistance to team members and other departments.
• Identify issues, determine affected areas, estimate impact, and lead resolution efforts.
• Prepare presentations to report findings to leadership.
• Manage data retrieval and analysis on multiple projects independently.
• Act as a resource for other department members and provide training and guidance.

Qualifications:

• Bachelor's degree in business or related field with 5 years of relevant work experience, or 9 years of related work experience in lieu of a degree.
• Strong knowledge of Claims, Encounters, and Supplemental Data.
• Expert knowledge of CMS rules and guidance for Risk Adjustment Submissions.
• Experience with initial, mid-year, and final sweep submissions.
• Familiarity with RAPS or EDPS/EDS, CSSC Operations, and CMS Files (999, 277CA, MAO-01, MAO-02, MAO-04, MMR, PPR, TRR, DTRR).
• Experience with Medicare, Medicaid, and ACA Commercial Data Submissions.
• Proficiency in extracting data from relational databases and performing data analysis.
• Ability to handle multiple tasks with competing priorities.
• Effective independent and team work skills with diverse professional backgrounds.
• Decision-making skills based on analysis and business needs.
• Ability to challenge the status quo and bring new perspectives.
• Strong analytical, software, and problem-solving skills.
• Excellent collaborative, interpersonal, oral, and written communication skills.
• Proficiency in Microsoft Office Suite.

Nice to Have:

• Proficiency with data warehouses and querying tools such as SQL.

Contact: kgregor@judge.com

This job and many more are available through The Judge Group. Find us on the web at www.judge.com

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