Clinical Insights Specialist

3 days ago

Manila, National Capital Region, Philippines beBeeHealthcare Full time $21,600 - $21,840
Job Opportunity: Clinical Insights Specialist

This role focuses on providing crucial support to clinical and coding operations through accurate data analysis. The ideal candidate has a solid background in U.S. healthcare data, understands medical coding and risk adjustment models, and can deliver insights that drive improved patient outcomes and operational performance.


Key Responsibilities:
  • Analyze clinical data to identify opportunities for precise Hierarchical Condition Categories (HCC) coding and Risk Adjustment Factor (RAF) optimization
  • Review patient records, claims data, and provider documentation to ensure accurate risk-adjusted coding
  • Collaborate with coding and clinical teams to support audit processes and data integrity initiatives
  • Develop reports and dashboards that inform care management, risk adjustment, and quality improvement initiatives
  • Track key performance metrics and highlight trends or anomalies in healthcare datasets
  • Maintain compliance with CMS risk adjustment guidelines and payer-specific requirements
  • Promote efficient data validation procedures to ensure consistent analysis results

Required Skills:
  • Minimum of 2 years' experience in U.S. healthcare analytics, medical coding, or risk adjustment
  • Demonstrated knowledge of HCC coding, RAF scoring, and ICD-10 coding standards
  • Experience working with healthcare datasets such as claims, EMR, encounter data
  • Proficiency in using tools like Excel, Google Sheets, and data visualization platforms (e.g., Tableau, Power BI)
  • Familiarity with CMS guidelines and risk adjustment methodologies
  • Strong analytical, organizational, and communication skills
  • Able to work independently in a remote environment with minimal supervision

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