Also referred to as:
Health Risk Adjustment Analyst II, Insurance Risk Adjustment Analyst II, Insurance Risk Rating Analyst II
Requirements and Responsibilities
Risk Adjustment Data Analyst II analyzes healthcare data to assess patient risk scores and ensure accurate reimbursement calculations. Utilizes patient health factors, their likely use of health care services, and the costs of those services to calculate payment adjustments, forecast revenue impacts, and identify coding gaps. Being a Risk Adjustment Data Analyst II reviews medical claims, encounter data, and electronic health records to ensure proper coding of diagnoses and accurate reporting to government healthcare programs. Prepares reports on risk adjustment performance and recommends strategies to optimize financial performance while maintaining regulatory compliance. Additionally, Risk Adjustment Data Analyst II supports audits and data validation activities to ensure compliance with risk adjustment program requirements. Requires a bachelor's degree. Typically reports to a manager. The Risk Adjustment Data Analyst II occasionally directed in several aspects of the work. Gaining exposure to some of the complex tasks within the job function. To be a Risk Adjustment Data Analyst II typically requires 2-4 years of related experience.
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