Risk Adjustment Health Data Analyst
Nebraska Blue
- # Risk Adjustment Health Data AnalystApplyremote type: Hybridlocations: Remote flexibility for candidates in FL, IA, KS, MN, MO, NE, ND, or TXtime type: Full timeposted on: Posted 3 Days Agojob requisition id: JR101331At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve.Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there’s no greater time for forward-thinking professionals like you to join us in delivering on it! As a member of Team Blue, you’ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.The Healthcare Analytics role supports the Risk Adjustment Programs team by analyzing healthcare data to evaluate program performance, measure financial and clinical impact, and identify opportunities for improvement. This role develops reporting, forecasts, and actionable recommendations that inform Risk Adjustment strategy, intervention planning, and operational decision-making.**Candidates applying to this position may be hybrid or remote and can live in one of the following states: Florida, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and Texas.****What you'll do:*** Analyze healthcare claims, pharmacy, lab, and Risk Adjustment submissions data to evaluate intervention and program performance.* Develop, maintain, and present reports that measure intervention ROI, incremental conditions captured, risk score impact, revenue impact, and other key Risk Adjustment performance metrics.* Partners with internal teams to support Risk Adjustment analytics needs, intervention planning, reporting enhancements, and issue resolution.* Stay current on healthcare analytics, Risk Adjustment trends, tools, methodologies, and regulatory considerations; recommend process or reporting improvements where appropriate.* Provide analytic solutions on ad-hoc requests with little oversight by senior analysts.**To be considered for this position, you must have:*** Bachelor’s degree or equivalent* 3+ years’ experience in data or statistical analysis, or experience with managing and analyzing data for Government programs (Medicare Advantage, Commercial ACA) including experience working with healthcare-related data, such as claims, encounters, provider data, CMS files, EDGE response files, or similar datasets.* Proficiency in SQL and data analytics.* Experience with Microsoft Azure DataBricks.* Advanced Excel skills.* Strong analytic skills to construct impactful findings from the extraction, manipulation and understanding of various types of data.* Successful experience working in a cross-functional environment.* Experience effectively communicating with stakeholder groups.**The strongest candidates for this position will also possess:*** Proficiency working within an environment that utilizes Agile and/or Project Management techniques.* Successful experience with creating analytic models based on data trends, business program ROI, data Quality Analysis, etc.* The translation of data findings into informative reports and visual outputs trusted by stakeholders to make business decisions.* Experience designing or building self-service content.* Advanced SQL knowledge.* Understanding of Health Insurance Operations knowledge including claims, enrollment, payment mechanisms, care management, employer reporting and the ability to stay current on healthcare industry knowledge.* Strong knowledge of the MA risk adjustment models, concepts, payment methodologies and submission requirements.* Ability to use advanced-level calculations in the transforming of data sets into usable data.* Ideal candidate would have experience using data manipulation tools such as R and/or Python.* Proficiency of visualization best practices as well as Proficiency with visualization tools such as PowerBI and/or Tableau.* Experience with Microsoft Azure DataBricks.* Ability to translate technical requirements into business deliverables.* Skilled in navigating relationships with external partners such as vendors, providers, groups, brokers, etc.* Master's Degree in Business, Analytics, Information Technology or a Related Field.Learn more about what makes BCBSNE such an exceptional place to work by visiting NebraskaBlue.com/Careers.*We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.*
- J-18808-Ljbffr Nebraska Blue
Vacancy posted 3 days ago
Similar jobs that could be interesting for youBased on the Risk Adjustment Health Data Analyst in Florida, NY vacancy
- Nebraska Blue Cross and Blue Shield is seeking a Risk Adjustment Health Data Analyst to join our Healthcare Analytics team. You will analyze claims, enrollment, and risk adjustment submissions to evaluate program performance and identify opportunities for improvement. The...RiskRemote job
- Baptist Health is seeking a Certified Professional Coder to perform medical record reviews and coding to support risk adjustment and Medicare compliance. The role involves identifying documentation gaps, communicating with providers, and ensuring accurate ICD-10-CM coding...Risk
- Oscar Health is hiring an Associate, Risk Adjustment Auditor for their Risk Adjustment team. This remote role requires conducting quality audits specific to ICD-10 code abstraction and ensuring compliance with coding standards. The ideal candidate holds a Bachelor's degree...RiskRemote job
- Cano Health, LLC is seeking a Risk Adjustment Coder to join our hybrid team in New York. The coder will identify and document coding information crucial for Clinical Condition Categories and ensure diagnosis code accuracy. This role involves regular collaboration with...Risk
- CVS Health is seeking a Sr. Manager of Program Management within Revenue Integrity to lead vendor management, procurement, and quality... ...has 7+ years in consulting or program management with Risk Adjustment experience and strong relationship skills. #J-18808-Ljbffr CVS...Risk
$56.2k - $101k
...million members. Centene is transforming the health of our communities, one person at a time.... ..., education and training regarding risk adjustment to ensure accurate CMS payment and improve quality of care. Analysis of MRA data to identify patterns and development of interventions...RiskFull timePart timeWork at officeRemote workFlexible hours- ...Sinai Medical Center of Florida, Inc. is seeking a Certified Risk Adjustment Coder to ensure accurate coding and documentation standards.... ...with a strong knowledge of ICD-10-CM and CPT. Benefits include health insurance, paid time off, and tuition reimbursement. #J-1880...Risk
- NeueHealth is seeking a Coding Coordinator to ensure accurate coding and compliance across risk adjustment and Medicare Advantage programs. The role focuses on primary coding contacts for compliance oversight, accuracy, and opportunities for improvement. Responsibilities...Risk
- Centene Corporation in the United States is seeking a Senior Actuarial Analyst to support Risk Adjustment Actuarial Services. You will assist in financial analysis, pricing and risk assessment to estimate outcomes and ensure compliant reporting. The role partners with...RiskRemote job
$143.62k - $229.79k
...Job Description As a Consulting Actuary -ACA Risk Adjustment, you will play a pivotal role in delivering a wide array of actuarial and analytical... ...partnerships with vendors, auditors, regulators, and health care providers, including effective negotiation of contracts...RiskBlue Cross and Blue Shield of North Carolina
Florida, NY4 days ago- Blue Cross NC is seeking a Consulting Actuary - ACA Risk Adjustment to lead pricing strategies, actuarial initiatives, and advanced risk adjustment analyses across segments. The role requires strong leadership and collaboration to drive financial performance and innovative...Risk
$87.7k - $157.8k
.... Centene is transforming the health of our communities, one person... ...impacting operations, systems, and data, and maintain awareness of... ...stakeholders, delivering risk‑informed insights, recommendations... ...schedules. Actual pay will be adjusted based on an individual’s skills...RiskFull timePart timeWork at officeRemote workFlexible hours- ...company expertise. Our Crop Division has been helping farmers manage risk since 1915 and is one of the few private companies authorized by... ...part‑time. Hours fluctuate based on seasonal needs. As a Crop Adjuster, You Will Understand and work claims for all major crops,...RiskFull timePart timeSeasonal work
- ...successful production launch Own project scope, schedule, risks, decisions, and stakeholder alignment Develop detailed implementation... ...lessons learned and apply best practices Assess project health and proactively adjust plans Requirements 3-7 years of project management,...Risk
- Centene Corporation is seeking a senior regulatory, privacy and risk management professional to interpret laws, regulations, and contracts affecting operations across health programs. This role translates requirements into structured obligations and supports enterprise...Risk
$23.21 - $29.48 per hour
Baptist Health is the region's largest not-for-profit healthcare organization, with 12... ...and billing and compliance with Medicare Risk Adjustment metrics. Supports continuum of patient care... ...to interpret, analyze and abstract data/documentation. Comprehensive knowledge of...RiskRemote job- ...leaders and executive stakeholders to turn data into insight and action Design, build,... ...and complex datasets to identify trends, risks, bottlenecks, and improvement opportunities... ...3+ years of experience as a Data Analyst or similar role supporting operational teams...Risk
Jobtailor
Florida, NY5 hours ago - ...Home Care, Florida’s largest independent Medicare-certified home health provider, has been delivering high-quality, patient-centered care for over two decades, and we’re looking for a Junior Data Analyst to join our award-winning team. Key Responsibilities Write SQL queries...Flexible hours
Pinnacle Home Care
Florida, NY1 day ago - ...Things Better, and our Product Analyst plays a pivotal role in... ...your next adventure starts here! Health & Wellness: Company-sponsored... ...code on a number of different risk profiles. Keep up to date of competitor... ..., business, or statistics. Data Analytics and experience in...RiskContract workTemporary workLocal area
$214.7k - $306.71k
...currently one of the most successful full-risk Medicare Advantage providers in the... ...affordable VIP care that delivers better health. In order to achieve our vision and deliver... ...effectiveness for each patient in their risk adjusted panel of at least 400 patients. They...RiskTemporary workWork at office$100k
Overview Job Title:Data Analyst - Power BI & Aviation AftermarketLocation: On-Site - Broward County, FLJob Type:Perm Full-TimeBase Salary... ...actionable insights. Track and visualize KPIs, highlighting potential risks and growth prospects. Develop scorecards to measure vendor,...RiskPermanent employment- Raymond James Financial, Inc. seeks a Lead Technical Data Analyst to own requirements and data-mapping for our AWS data platform. You’ll translate... ...clear, testable user stories, and collaborate with engineers, risk analysts, and platform teams to deliver robust data solutions....RiskWork at office
- The Health Care District of Palm Beach County seeks a nursing professional to manage data analysis, risk management, and compliance for the Skilled Nursing Center. This role interfaces with legal counsel and submits required regulatory reports, supporting quality of care...Risk
- ...The Village Center Community Development District in Florida is seeking a Risk Management Generalist to support safety, manage claims, and assist district operations. This role involves data entry, COI handling, and coordination with insurers and vendors. It is a full...RiskFull time
DistrictGov
Florida, NY4 days ago - Lake Bennet Center in New York is seeking a Risk Manager to oversee Risk Management and Quality Assurance programs. This position requires... ...various quality initiative programs. We offer comprehensive health benefits, PTO, and employee perks. You'll thrive in a supportive...Risk
$98.7k - $164.5k
...accessible and affordable. Here, we focus on the health, happiness, and well‑being of you and... ...to hear from you. Join McKesson’s Global Risk Management Team as a Risk Manager... ...analyze, and validate operational exposure data for insurance underwriting submissions. Review...RiskWork at officeRemote workMcKesson
Florida, NY3 days ago- Jobtailor in New York is seeking a Senior Business Analyst to turn structured and unstructured data into actionable insights that improve marketing ROI. You... ..., and presentations to diagnose issues, identify risks, and guide decision-making, while partnering with cross...Risk
- Florida Department of Veterans Affairs is seeking a Nursing Program Specialist - RM to lead the facility's risk management program in Saint Augustine, FL. The role requires RN licensure in Florida and at least 3 years of management-level risk experience in a skilled nursing...Risk
- ...skilled nursing facility, school health program, transportation... ...assigned department. Analyze data to identify areas for improvement... ...implemented quality initiatives and adjust strategies as necessary.... ...proactive approaches to mitigating risk. Collaborate with Risk...RiskLocal area
- ...Job Description: Risk Manager (RN/LPN) Multi-Facility Coverage Job Description: Risk Manager... ...: Salary Grade: Date Approved: Catholic Health Services | South Florida Protect Patients.... ..., and adverse events. Analyze and trend data to identify risk exposures and opportunities...RiskInterim roleWork at officeLocal area
Hireez
Florida, NY1 day ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Risk Adjustment Health Data Analyst. Be the first to apply!
Related searches
- risk consultant Florida, NY
- risk compliance officer Florida, NY
- risk analyst Florida, NY
- governance risk & compliance analyst Florida, NY
- senior quantitative risk analyst Florida, NY
- operational risk consultant Florida, NY
- it risk analyst Florida, NY
- risk officer Florida, NY
- operational risk specialist Florida, NY
- senior financial data analyst Florida, NY