Risk Adjustment Business Analyst I

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At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.

Job Summary

Under the general direction of the Director, Risk Adjustment Programs, the Risk Adjustment Business Analyst I is responsible to manage all aspects of risk adjustment related activities associated with program. The Risk Adjustment Business Analyst I will support the team through responsibilities that include, but are not limited to:

• Develop a strong relationship with key risk adjustment stakeholders (e.g., Provider Network Management Account Executives, Quality and HEDIS leaders, etc.).
• Facilitate review and approval of program collaterals/communications for both implementation of new program components or to support ongoing needs of the program.
• Generate and monitor meaningful performance and financial metrics to evaluate performance of each line of business. Report timely and accurate information to management through standardized dashboards and reports. Broadcast results of reporting to stakeholders and ensure that any data anomalies or areas of concern are called to audience.
• Provide administrative support to coordinate and sometimes lead needed work sessions/projects with cross organization teams to implement new program components, perform preliminary root cause analysis and suggest resolution to correct issues.
• Serve as a POC for provider portal(s) and other vendor applications used that support the risk adjustment program.
• Track, research and resolve issues reported to risk adjustment from a myriad of sources (e.g., providers, Account Executives, leadership, etc.). Escalate issues to management for assistance in resolution. Progress and resolution communicated frequently with stake holders.
• Complete assigned analysis of data to identify areas for targeted campaigns to increase chronic diagnosis capture.
• Participates in goal and target planning activities within the department.
• Work to develop business knowledge, analytical skills and basic technical abilities.
• The Risk Adjustment Business Analyst I will develop knowledge to support all assigned markets, vendor activities, risk adjustment models (e.g., HCC, CDPS+RX, ACG, etc.) and concepts, as well as other health insurance data sets available to support the program.

Education/Experience

• Associate’s Degree.
• Solid knowledge of Health Insurance, Claims Data, Manage Care, Medicare and/or Medicare plans.
• 1 to 2 years of analytic experience or equivalent education/experience in Healthcare, Medicaid, Medicare or Risk Adjustment.

Other Skills

• Solid knowledge of MS Office Suite with demonstrated knowledge of MS Access and Excel.
• Knowledge of SQL, Hadoop and/or Tableau is a plus.

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.