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Risk Adjustment Analyst - Medicare Health Insurance.

Company: Fallon Health
Location: Worcester
Posted on: February 13, 2019

Job Description:

RESPONSIBILITIES

Analyze & Resolve Claims/ Encounter Data Errors

* Encounter Data/Claims SME

* Prioritize error resolution

* Collaborate with internal departments to work toward error resolution

* Manage Encounter Data software

Product Line Support

* Educate specified product line management on drivers of variances from budget for all revenue streams.

* Meet regularly with the specified product manager(s) to identify and implement reports to improve revenue optimization efforts.

Regulatory Compliance

* Knowledgeable of data submission timelines and lags RA factor impact

* SME for regulatory rate release notes and summaries review and oversee application of risk adjustment changes specific to Annual Rate Notices and interim rate bulletins from state and federal regulatory agencies.

Corporate Project Support

* Participate in corporate projects and subgroup meetings. Complete analyses related to corporate projects and business needs as required.

QUALIFICATIONS

* BA or BS Business Administration, Finance, Economics, Healthcare Administration, other

* Experience working in Medicare, Medicaid and/or Merged Markets support role: Risk Adjustment, Regulatory, Enrollment, Internal Audit, Accounting, Underwriting, Marketing, Claims other

* Proficient/Advanced in Excel

* Ability to create presentations & exhibits in formats that meet various audience levels

* SQL- Navigator and/or SAS experience

* -7 years Managed Care setting

* -5 years - Excel

* -3 years SQL/SAS Experience



PM16

Fallon Health is an equal opportunity employer. It is very important for us to maintain a consistant hiring process for every candidate. In addition, we are also a government contractor with requirements to report on our Affirmative Action planning. To that end, we require everyone to apply online.

If you do not have access to a computer or need assistance completing the application process, please contact Human Resources at 1-508-368-9893 (TRS 711).

Keywords: Fallon Health, Worcester , Risk Adjustment Analyst - Medicare Health Insurance., Professions , Worcester, Massachusetts

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