Risk Adjustment Analyst - Remote

Risk Adjustment Analyst - Remote

REQ-2025-170
Portland, ME

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.

Position Summary

The Risk Adjustment Analyst provides analytic, technical, and decision support to the Risk Adjustment Team utilizing third party software as well as the data warehouse as key sources of data. The Analyst works closely with our internal customers related to their department-specific action plans by providing accurate, timely, and consistent information enabling informed decisions related to risk adjustment activities. The Analyst provides subject matter expertise based on content knowledge and analytical capabilities to guide and educate customers on risk adjustment from a range of operational lenses and levels of analysis. This individual also participates in team projects and special analytical assignments in their area of expertise.
Job Description

Key Outcomes:

• Conducts analyses to inform business decisions and activities related to risk adjustment
• Develops monitoring and tracking reports and dashboards and conducts analyses to inform business decisions and activities related to risk adjustment
• Provides analytic mentorship and guidance to operational departments related to risk adjustment
• Liaison with key supporting departments, IT and Informatics, on risk & revenue optimization
• Tracks progress and activities within their assigned key initiatives
• Provides standardized reports and processes for analyzing data from multiple sources
• Works directly with vendors to coordinate needs, resolves issues, and implements data transmission processes
• Participates in vendor research, software installation, configuration support, and interface development applications as needed
• Supports CMS HCC Risk Adjustment modeling
• Maintains and is a proficient user of third-party analytical tools and reporting platforms related to risk profile analysis and HCC coding
• Recommends tools and methodologies that can be deployed at the organizational level, to the departments, and with external partners

Education/Experience:

• Bachelor's degree or equivalent experience required
• Minimum of 3 years' experience related to reporting and analysis of health care data ideally in the areas of managed care, health care delivery, code sets, and/or reimbursement
• Experience in developing cost-benefit and ROI analyses

Skills/Knowledge/Competencies (Behaviors):

• Strong interpersonal and communication skills, both verbal & written
• Solid skills in providing analytic results using a variety of quantitative, qualitative, and visualization mediums
• Strong analytical abilities with attention to detail
• Ability to manage multiple priorities and deadlines
• Familiarity with healthcare applications and business management software applications
• Proven ability to pull data from multiple sources and provide complex analyses presented to a wide range of audiences
• Proven strength in data management practices
• Demonstrated knowledge of Microsoft Office products, especially Transact-SQL and data visualization tools (Cognos,Tableau)
• Capable of determining when issues need escalation or prioritization with self-starter reliability and follow-through
• Capable of utilizing a variety of analytical techniques to solve problems.

This position is not eligible for immigration sponsorship.

We are an equal opportunity/affirmative action employer.

Do you have a question about careers at Martin's Point Health Care? Contact us at: jobinquiries@martinspoint.org


To apply, visit https://martin.wd1.myworkdayjobs.com/en-US/MPHC/job/Portland-ME/Risk-Adjustment-Analyst_REQ-2025-170.







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