Risk Adjustment Analyst - Community Health Choice
Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:
• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women
• Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR
• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.
• Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.
Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.
Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.
Skills / Requirements
JOB SUMMARY: The Risk Adjustment Analyst will utilize and evaluate claims, authorization, member and provider data to assist the Director of Quality Validation to develop, track and monitor healthcare quality metrics, cost and make recommendations to support business decisions. The Risk Adjustment Analyst will exhibit familiarity with using data from various relational databases. The Risk Adjustment Analyst generates departmental performance reports, validates results and makes recommendation on how to interpret information. Performs other duties as assigned.
Education/Specialized Training/Licensure: Bachelor's Degree in Business. Public Health, Mathematics or related field. Master's degree, MBA or MHA preferred.
Work Experience (Years and Area):
Two (2) years of work experience in Analytics, Reporting, Business Intelligence or related area preferred.
Two (2) years in Healthcare highly preferred.
Experience working on Commercial Risk Adjustment is preferred
Experience with SQL query writing and using reporting tools (e.g. MS Excel, SQL Reporting Services, Power BI etc.).
Basic Medical knowledge of ICD9 and ICD10 codes preferred.
Software Operated: Microsoft Office (Word, Outlook, Excel)
- Knowledge of data analysis methodology, understanding of data analytic tools and good communication and documentation skills.
- Experience developing actionable reporting using key metrics communicated in an easy to understand manner.
Above Average Verbal (Heavy Public Contact)
Writing /Composing: Correspondence / Reports
Other Skills: Analytical, Mathematics, Medical Terminology, MS Word, MS Excel