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3 days ago
Job Title: Healthcare Data Analyst
We are seeking a detail-oriented and analytical professional to support clinical and coding operations. This role involves accurate data analysis, specifically Hierarchical Condition Categories (HCC), Risk Adjustment Factor (RAF) scoring, and healthcare claims review.
Key Responsibilities:- Analyze clinical data for HCC coding and RAF optimization
- Review patient records, claims data, and provider documentation for risk-adjusted coding accuracy
- Collaborate with coding and clinical teams to support audit processes and data integrity
- Generate reports and dashboards for care management, risk adjustment, and quality improvement initiatives
- Track performance metrics and highlight trends or anomalies in healthcare data sets
- Ensure compliance with CMS risk adjustment guidelines and payer-specific requirements
- Minimum 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
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