JOB SUMMARY: The Risk Adjustment Analyst will utilize and evaluate claims, authorization, member and provider data to assist the Director of Quality Validation to develop, track and monitor healthcare quality metrics, cost and make recommendations to support business decisions. The Risk Adjustment Analyst will exhibit familiarity with using data from various relational databases. The Risk Adjustment Analyst generates departmental performance reports, validates results and makes recommendation on how to interpret information. Performs other duties as assigned.
MINIMUM QUALIFICATIONS: Education/Specialized Training/Licensure: Bachelor's Degree in Business. Public Health, Mathematics or related field. Master's degree, MBA or MHA preferred.
Work Experience (Years and Area):
Two (2) years of work experience in Analytics, Reporting, Business Intelligence or related area preferred.
Two (2) years in Healthcare highly preferred.
Experience working on Commercial Risk Adjustment is preferred
Experience with SQL query writing and using reporting tools (e.g. MS Excel, SQL Reporting Services, Power BI etc.).
Basic Medical knowledge of ICD9 and ICD10 codes preferred.
Software Operated: Microsoft Office (Word, Outlook, Excel)
Other Requirements - Knowledge of data analysis methodology, understanding of data analytic tools and good communication and documentation skills. - Experience developing actionable reporting using key metrics communicated in an easy to understand manner.
Communication Skills: Above Average Verbal (Heavy Public Contact) Writing /Composing: Correspondence / Reports
Other Skills: Analytical, Mathematics, Medical Terminology, MS Word, MS Excel
The Harris Health System is a fully integrated healthcare system that cares for all residents of Harris County, Texas. We are the first accredited healthcare institution in Harris County to be designated by the National Committee for Quality Assurance as a Patient-Centered Medical Home, and are one of the largest systems in the country to achieve the quality standard. Our system includes 23 community health centers, five school-based clinics, a dental center and dialysis center, mobile health units, a rehabilitation and specialty hospital and two full-service hospitals.Ben Taub Hospital is a world renowned Level I Trauma Center with 586 licensed acute-care beds and provides a wide range of specialty care outpatient services. Lyndon B. Johnson Hospital is a 328 licensed bed acute-care hospital with a newly expanded Level III trauma center and a distinguished regional center for neonatal intensive care for high-risk deliveries.Harris Health is a teaching system for Baylor College of Medicine and The University of Texas Health Science Center at Houston (UTHealth). We train the next generation of healthcare providers on the latest medical procedures and technological breakthroughs.With... our fully integrated electronic medical records system, we offer patients the convenience and assurance that their medical history is accurate, safe and available when and where it is needed. Our Medical Home designation ensures that we offer a full range of preventive, specialty and acute care services for the entire family.