Data Driven Healthcare Specialist

2 days ago

Mandaue City, Central Visayas, Philippines beBeeHealthcare Full time $21,600

We are seeking a detail-oriented and analytical professional to join our team as a Healthcare Analyst (Remote). This role focuses on supporting clinical and coding operations through accurate data analysis, specifically involving Hierarchical Condition Categories (HCC), Risk Adjustment Factor (RAF) scoring, and healthcare claims review. The ideal candidate has a solid background in U.S. healthcare data, understands medical coding and risk adjustment models, and can deliver insights that support improved patient outcomes and operational performance.

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 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

This role offers the opportunity to make a measurable impact in improving patient care and data-driven clinical outcomes while enjoying the flexibility of remote work.

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