Data Driven Healthcare Professional

2 days ago

Pasig, National Capital Region, Philippines beBeeHealthcare Full time $21,600
Healthcare Analyst Role Summary

We are seeking a detail-oriented professional to support clinical and coding operations through accurate data analysis, focusing on Hierarchical Condition Categories (HCC) scoring, risk adjustment, and healthcare claims review.

Key Responsibilities:
  • Analyze clinical data to identify opportunities for HCC coding optimization and improve RAF scores
  • Review patient records, claims data, and provider documentation to ensure risk-adjusted coding accuracy and compliance
  • Collaborate with coding and clinical teams to support audit processes, data integrity, and quality improvement initiatives
  • Generate reports and dashboards that support care management, risk adjustment, and quality improvement efforts
  • Track performance metrics and highlight trends or anomalies in healthcare data sets
  • Ensure adherence to CMS risk adjustment guidelines and payer-specific requirements
  • 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, ICD-10 coding standards, and healthcare data sets
  • Experience working with 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 with minimal supervision
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, ACOs, or Medicare Advantage organizations

This role requires a solid background in U.S. healthcare data, understanding of medical coding and risk adjustment models, and the ability to deliver insights that support improved patient outcomes and operational performance.

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