Sr. Business Analyst - Risk Adjustment Loc: Huntington Beach, CA

100,000 - 200,000

Job Description:

Responsibilities

  • Develop an in-depth knowledge of various risk adjustment and quality programs ( CMS-HCC risk model, CMS HEDIS / STAR Quality measures, Health Exchange Risk Model, Medicaid Risk Model )
  • Build and maintain financial models to support the business
  • Produce clear, well-formatted reports in a concise, yet meaningful manner for various audiences
  • Develop and maintain operational and financial reports to clearly communicate actual results and variances to plan, forecast and budget to department and business leaders
  • Knowledge of medical terminology and coding ( ICD-10 diagnostic coding )
  • Validate all reports for accuracy and reasonableness
  • Coordinate activity / data exchange with 3rd party vendors to support business activities
  • Assist in developing business level metrics to enable business leaders to make informed decisions around risk adjustment opportunities and operational activities
  • Conduct cost-benefit analysis, calculate cost impact, and summarize findings
  • Ability to independently research, interpret and process data into actionable reports and/or processes
  • Automate and streamline reporting and business processes
  • Prepare ad hoc financial analyses and other duties as necessary to support the team

Qualifications

Required Qualifications:

  • Bachelor??s Degree in Accounting, Finance or related field
  • 3+ years relevant risk adjustment, finance and/or accounting experience
  • Strong analytical and communication skills with the ability to problem solve
  • Excellent Microsoft Excel, PowerPoint, Access / database and financial modeling skills
  • Proficient knowledge of SQL
  • Strong organizational and planning skills
  • Must meet established deadlines and produce accurate work produc

Required Qualifications

  • Bachelor??s Degree in Accounting, Finance or related field
  • 3+ years relevant risk adjustment, finance and/or accounting experience
  • Strong analytical and communication skills with the ability to problem solve
  • Excellent Microsoft Excel, PowerPoint, Access / database and financial modeling skills
  • Proficient knowledge of SQL
  • Strong organizational and planning skills
  • Must meet established deadlines and produce accurate work product

Preferred Qualifications

  • CPA or MBA
  • Healthcare experience
  • Self-driven in nature with minimal supervision on day to day activities
  • Work independently, take initiative, and meet deadlines
  • Presentation and reporting experience
  • Develop an in-depth knowledge of various risk adjustment and quality programs ( CMS-HCC risk model, CMS HEDIS / STAR Quality measures, Health Exchange Risk Model, Medicaid Risk Model )
  • Build and maintain financial models to support the business
  • Produce clear, well-formatted reports in a concise, yet meaningful manner for various audiences
  • Develop and maintain operational and financial reports to clearly communicate actual results and variances to plan, forecast and budget to department and business leaders
  • Knowledge of medical terminology and coding ( ICD-10 diagnostic coding )
  • Validate all reports for accuracy and reasonableness
  • Coordinate activity / data exchange with 3rd party vendors to support business activities
  • Assist in developing business level metrics to enable business leaders to make informed decisions around risk adjustment opportunities and operational activities
  • Conduct cost-benefit analysis, calculate cost impact, and summarize findings
  • Ability to independently research, interpret and process data into actionable reports and/or processes
  • Automate and streamline reporting and business processes
  • Prepare ad hoc financial analyses and other duties as necessary to support the team


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