Risk Adjustment Analyst

Risk Adjustment Analyst
Wheeling, WV
Full-Time
Underwriting
Manager

Will support the risk adjustment and coding management goals with regard to the risk adjustment models.

The position will be involved in developing, coordinating, and analyzing the impact of various activities used to support risk adjustment optimization.

This would require evaluating and analyzing the effectiveness of prospective and retrospective programs, including reviewing claim/member/provider data.

The Risk Adjustment Analyst will need to be able to work effectively with other team members within the organization in order to close clinical care and diagnosis coding gaps.

This will help to ensure complete and accurate capture of revenue, based on the risk adjustment models.

  1. College degree or a combination of education/experience in the health care industry;
  2. Computer experience with Microsoft Word, Excel, Power Point and Outlook;
  3. Strong organizational, verbal and written communication skills;
  4. Knowledge of the health care system;
  5. Excellent ability to work independently as well as part of a team.

  1. Certified Coder;
  2. Prior Managed Care experience;
  3. Medical terminology;
  4. Knowledge of ICD and CPT coding (prefer certification);
  5. Familiar with medical and hospital claims;
  6. Familiar with prescription coding (NDC).

Employment Documents

EEO

Or, if you are interested in a fast-paced career with us, please send resume with salary requirements to:

HR Department 
1110 Main Street
Wheeling, WV 26003-2704
hr@healthplan.org