Senior Healthcare Operations Specialist

2 days ago


Mandaluyong City, National Capital Region, Philippines beBeeHealthcare Full time $21,600
Job Overview:
A skilled Healthcare Data Analyst is required to provide clinical and coding support for remote operations. This role involves thorough data analysis, specifically Hierarchical Condition Categories (HCC), Risk Adjustment Factor (RAF) scoring, and healthcare claims review.

About the Role:
  • 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.
  • Maintain documentation and data validation procedures to ensure consistent analysis.

Key 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.


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