Careers in Healthcare: Risk Adjustment Expert

6 days ago

Sorsogon, Bicol, Philippines beBeeRiskAdjustment Full time $21,600
Job Title:

Healthcare Data Specialist

Key Responsibilities:
  • Analyze clinical data to identify opportunities for accurate risk adjustment and Hierarchical Condition Categories (HCC) coding 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 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, 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 (e.g., Tableau, Power BI)
  • 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 (e.g., CPC, CRC) is a plus
  • Experience working with U.S. health plans, ACOs, or Medicare Advantage organizations

Drive positive change in patient care by leveraging data-driven insights.

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