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1 day ago
In this dynamic role, you will support clinical and coding operations through meticulous data analysis.
Key Responsibilities:- Analyze healthcare 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
- Develop 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
- Maintain compliance with CMS risk adjustment guidelines and payer-specific 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 with minimal supervision
- 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
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