Data Driven Clinical Outcomes Specialist

1 week ago

Biñan, Calabarzon, Philippines beBeeHealthcare Full time $21,600
Healthcare Analyst Position Summary

We are seeking a detail-oriented and analytical professional to join our team remotely. This role focuses on supporting clinical and coding operations through accurate data analysis, specifically involving Hierarchical Condition Categories (HCC) and risk adjustment models.

Key Responsibilities:
  • Analyze clinical data to identify opportunities for accurate HCC coding and RAF optimization
  • Review patient records, claims data, and provider documentation to ensure risk-adjusted coding accuracy
  • Collaborate with coding and clinical teams to support audit processes and data integrity
  • Generate reports and dashboards that support care management, risk adjustment, and quality improvement initiatives
  • Track performance metrics and highlight trends or anomalies in healthcare data sets
  • Support compliance with CMS risk adjustment guidelines
  • Maintain documentation and data validation procedures to ensure consistent analysis
Requirements:
  • Minimum of 2 years' experience in U.S. healthcare analytics, medical coding, or risk adjustment
  • Strong knowledge of HCC coding, RAF scoring, and ICD-10 coding standards
  • Experience working with healthcare data sets such as claims, EMR, encounter data
  • Proficient in using tools like Excel, Google Sheets, and data visualization platforms
  • Familiarity with CMS guidelines and risk adjustment methodologies
  • Excellent analytical, organizational, and communication skills
  • Ability to work independently in a remote environment
Preferred Qualifications:
  • Background in Nursing, Health Information Management, Public Health, or related fields
  • Certification in medical coding is a plus
  • Experience working with U.S. health plans or Medicare Advantage organizations

This role offers the flexibility of remote work while making a measurable impact in improving patient care and clinical outcomes.


Why This Role Matters:

The Healthcare Analyst will play a critical role in supporting our team's efforts to improve patient care and clinical outcomes. With your expertise and analytical skills, you will help drive data-driven decision-making and contribute to the development of innovative solutions.


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