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011260 CCA-Revenue Cycle Management

Position Summary:

The Risk Adjustment Business Analyst is responsible for understanding and interpreting complex programs, initiatives, and data through the employment of business requirements gathering, project management techniques, business systems analysis, and reporting using a variety of reporting platforms, systems, sources, and data formats. They will collaborate with other business units on the program and project structures, data gathering and transformation methodology, and will play an essential role in driving Risk Adjustment (RA) Program performance.

Supervision Exercised:

• No, this position does not have direct reports.

Essential Duties & Responsibilities:

• Identifying opportunities for improvement that drives risk adjustment initiatives and program.

• Operational Business Partner supporting vendor management, internal business partners and clinical delivery partners, ensuring all identified gaps are addressed timely

• Support Provider Network Management

• Associate will be responsible for systems and processes for all essential Health Plan risk adjustment program activities including identifying gaps in coding and documentation

• Prospective and retrospective reviews, analytics and reporting

• Ensuring RA program activities are being executed as planned

• Manage direct reports for Program Initiatives

Working Conditions:

• Standard office conditions.

Required Education (must have):

• Bachelor’s degree or an equivalent combination of education and highly relevant work experience

Desired Experience (nice to have):

• Two plus years' experience in healthcare industry or related field which includes direct or indirect work with public health certificate/coursework, claims management systems, EMR platforms, healthcare regulations, Risk Adjustment MA/HHS, project management, data visualization, or other clinical related background

Required Knowledge, Skills & Abilities (must have):

• High-level of knowledge of Microsoft software suite including Word, PowerPoint, Visio and intermediate to Advanced skill level with Microsoft Excel.

• Understanding of medical terminology and familiarity with medical records.

• Ability to interact and communicate effectively with healthcare providers.

• Strong communication and meeting facilitation skills.

• Strong written skills (process documentation, software documentation, etc.).

• Ability to effectively manage time, prioritize work, multi-task across many assignments without reminders or prompting from management.

• Working knowledge of the provider-based healthcare industry and Risk Adjustment preferred.

Required Language (must have):

• English

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled

Please note employment with CCA is contingent upon acceptable professional references, a background check (including Mass CORI, employment, education, criminal check, and driving record, (if applicable)), an OIG Report and verification of a valid MA/RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.