POSITION SUMMARY/RESPONSIBILITIES

The Risk Adjustment Data Analyst supports Community First Health Plans' Risk Adjustment program through data analysis, reporting, medical record retrieval, and performance monitoring activities. Coordinates with internal departments, provider networks, and external vendors to ensure accurate and timely collection, analysis, and reporting of risk adjustment data. Utilize health informatics and analytics tools to identify trends, monitor key performance indicators, support Hierarchical Condition Category (HCC) capture, and improve risk adjustment outcomes. Assists with medical record retrieval initiatives, data validation, provider performance analysis, and regulatory reporting to ensure compliance with CMS requirements and organizational goals.

EDUCATION/EXPERIENCE

Bachelor’s degree in a related field preferred. Two (2) years of experience in healthcare data analysis and medical record retrieval required. Experience in Risk Adjustment, managed care, health plan operations, or healthcare analytics preferred. Knowledge of healthcare data, electronic health records (EHRs), and medical record retrieval processes preferred. Proficiency in Microsoft Excel and strong analytical, organizational, and communication skills required. Ability to work effectively with providers, vendors, and cross-functional teams.

CERTIFICATION

Coding certification within 2 years of employment (e.g., Certified Professional Coder - CPC, Certified Coding Specialist - CCS and/or data analytics certification (e.g., CHDA, Microsoft Power BI Data Analyst Associate) within two (2) years of employment, based on the requirements of their role.