Data Risk Analyst

Data Risk Analyst

Location: Phoenix, AZ

The Risk Adjustment Analyst serves as a data and strategic specialist who tracks health plan performance and financial risk. By using advanced coding methodologies and data extraction tools they bridge the gap between clinical documentation and actuarial health forecasting. Their overarching goal is to maintain absolute regulatory compliance while optimizing organizational revenue.

Must Have

Data Analysis Modeling: Gather clean and consolidate financial claims, pharmacy enrollment, and premium datasets into actionable models.

Risk Score Calculation: Analyze diagnostic patterns to calculate Risk Adjustment Factors RAF and forecast financial impacts using clinical metrics.

Coding Quality Compliance: Maintain deep familiarity with medical terminologies, ICD10CM coding, and Hierarchical Condition Categories HCC to isolate coding discrepancies or revenue gaps.

Audit Support: Provide backend reporting and data validation to assist with internal quality checks and federal Risk Adjustment Data Validation RADV audits.

Cross-functional Collaboration: Partner with clinical providers to deliver Documentation Improvement CDI training ensuring that medical charts comprehensively capture a patient’s overall disease burden.

Reporting Dashboards: Design custom automated dashboards and adhoc financial plans to report risk trends directly to executive leadership.

Skills: Advanced proficiency in SQL for relational databases paired with statistical modeling in Python, SAS, or R.

Nice to Have

Healthcare experience

Soft Skills

1. Strong communication and interpersonal skills

2. Good analytical and problem-solving skills

Mandatory Skills: Dimensional Data Modeling, MS SQL Server, Python for DATA, R - Data Science, SAS-Data Integrator Good to Have Skills: Statistics-Data Science