Healthcare Business Analyst – Medicare Financials/Risk Adjustment/IT


Job Description
Healthcare Business Analyst – Medicare Financials/Risk Adjustment/IT

Job Description

We are seeking a Healthcare Business Analyst to manage risk adjustment and financial reporting projects within the Data Management department
Job Responsibilities

As a Healthcare Business Analyst, you will coordinate and drive risk adjustment and financials reporting and analytics projects. You will also serve as a liaison between for the technical and functional teams.

Your specific duties as a Healthcare Business Analyst will include:

• Meeting with functional and information technology teams to frame Risk Adjustment and Financial analytical and reporting requirements
• Assessing the scope and impact of analytic and reporting projects
• Gathering and documenting business and technical requirements
• Performing the appropriate data analysis to validate the technical requirements
• Supporting the development teams in the understanding of the business and technical requirements
• Building data test cases and validating test results
• Managing user acceptance testing
• Coordinating and reporting overall project status to technical and business leadership
• Performing data and analytical services in support of optimizing risk adjusted revenue, maintaining compliance with CMS standards and modeling financial impacts of changes in risk adjustment data and methodologies.
• Collaborating regularly with internal departments and external vendors on risk adjustment projects.
• Leveraging industry resources to increase knowledge and improve ROI of risk adjustment activities.
• Building understanding of risk adjustment models in emerging business areas, including Medicaid.
• Working under general supervision.

Job Requirements

As a Healthcare Business Analyst you must be self-motivated and well organized. You must also have strong analytic and problem-solving skills as well as strong multitasking and time-management skills. You must also have excellent verbal and written communication, and interpersonal skills. It is vital that you be able to effectively communicate technical information to persons from both business and technical teams.

Specific qualifications for the Healthcare Business Analyst position include:

• Bachelor degree required.
• Masters in health related field or informatics preferred
• 5 years business and data analysis experience in Medicare Risk Adjustment and Financials for a health plan or other healthcare company
• Demonstrated experience in healthcare business intelligence, data warehousing or reporting
• Demonstrated experience managing business intelligence or reporting projects
• Demonstrated experience developing business and technical requirements for Medicare financial and risk adjustment reporting or business intelligence efforts
• Demonstrated data analysis experience using SQL, Access, Excel or other reporting/data mining tools
• Strong follow-through skills
• Knowledge of Medicare Advantage and Medicaid programs required.
• Familiarity with medical claims and medical terminology required.
• Knowledge of CMS risk adjustment mechanisms, ICD-9 coding , HCC hierarchy required.
As a Healthcare Business Analyst with Our client’s, you will be part of a growing company. Your hard work and professionalism will be rewarded with a competitive compensation package that includes:

• Medical and dental coverage
• 401(k) with generous company match
• Life insurance
• Direct Deposit

Contact Melanie Kirk
Empyrean Consulting, Inc.


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