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Associate Risk Adjustment Analyst Jobs in Idaho (NOW HIRING)

University of Idaho

University Risk Manager

Moscow, ID · On-site

$110K/yr

This position directly supervises the Risk Analyst position. Duties may include: * Insurance ... Associate in Risk Management (ARM) or comparable certification * Experience in claims investigation ...

Varsity Tutors

Finance Tutor

Rexburg, ID · Remote

$40/hr

... risk adjustment in valuation, and interpreting financial ratios. Adapts instruction using financial calculators, Excel modeling exercises, and case study analysis to support students from ...

Varsity Tutors

Finance Tutor

Idaho Falls, ID · Remote

$40/hr

... risk adjustment in valuation, and interpreting financial ratios. Adapts instruction using financial calculators, Excel modeling exercises, and case study analysis to support students from ...

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Associate Risk Adjustment Analyst information

What is the difference between Associate Risk Adjustment Analyst vs Risk Adjustment Analyst?

AspectAssociate Risk Adjustment AnalystRisk Adjustment Analyst
Required CredentialsTypically requires a bachelor's degree, certifications like CPC or RHIA are commonSimilar credentials, often with additional certifications like CRC or RAC
Work EnvironmentHealthcare organizations, insurance companies, consulting firmsSame as Associate Risk Adjustment Analyst, often with more experience
Employer & Industry UsageUsed in health insurance, healthcare analytics, and risk managementSame industry, usually a more experienced role

The main difference between an Associate Risk Adjustment Analyst and a Risk Adjustment Analyst lies in experience and responsibility level. The Associate role is often entry-level or junior, focusing on data collection and basic analysis, while the Risk Adjustment Analyst typically has more experience and handles complex data analysis and reporting tasks.

What are the key skills and qualifications needed to thrive as an Associate Risk Adjustment Analyst, and why are they important?

To thrive as an Associate Risk Adjustment Analyst, you need analytical skills, attention to detail, and a foundational understanding of healthcare data and coding, often supported by a degree in health information management or a related field. Familiarity with risk adjustment software, ICD-10 coding systems, and data analysis tools like Excel or SQL is commonly required. Strong communication, problem-solving abilities, and organizational skills help you collaborate across teams and manage complex data sets. These skills are crucial for accurately evaluating risk, ensuring regulatory compliance, and supporting effective healthcare decision-making.

What are some common challenges faced by Associate Risk Adjustment Analysts when working with healthcare data?

Associate Risk Adjustment Analysts often encounter challenges related to the complexity and variability of healthcare data, such as incomplete patient records, inconsistent coding practices, and evolving regulatory requirements. These factors require strong attention to detail and problem-solving skills to ensure accurate analysis and reporting. Collaborating closely with other teams, such as coding specialists and clinical staff, is essential to clarify data discrepancies and maintain data quality. Staying current with industry updates and adopting best practices can help mitigate these challenges and support effective risk adjustment processes.

What are Associate Risk Adjustment Analysts?

Associate Risk Adjustment Analysts are entry-level professionals who support healthcare organizations in reviewing and analyzing patient data to ensure accurate risk adjustment coding and reporting. Their work helps organizations receive appropriate reimbursement from health plans based on the health status of their patients. These analysts often validate diagnosis codes, identify documentation gaps, and assist in implementing process improvements to optimize risk scores. They typically work under the supervision of senior analysts or managers and may collaborate closely with coding, compliance, and clinical teams.
Risk Adjustment Analyst - Health Plan

Risk Adjustment Analyst - Health Plan

St. Luke's Health System

Boise, ID • On-site

Full-time

Medical, Dental, Vision, Retirement

Posted 16 hours ago

St. Luke's Health System (Idaho) rating

7.5

Company rating: 7.5 out of 10

Based on 205 frontline employees who took The Breakroom Quiz

225th of 872 rated healthcare providers

Job description

Description & Requirements
The Risk Adjustment Analyst serves as a strategic partner to the business segments within the St. Luke's Health Plan. In alignment with identified strategies and tactics, leads the development of business processes and delivery of insights and health insurance data analysis, while working with cross-functional stakeholders.
This role is specifically for a Risk Adjustment Analyst to bring their knowledge, technical skills, and experience in risk adjustment for QHP/ACA and Medicare Advantage to the St. Luke's Health Plan.
What You Can Expect:
  • Analyzes and interprets health insurance data, including eligibility, premium, medical, and pharmacy claims data. Subject matter expert on available health insurance data. A creative problem solver in applying that data to identify, escalate, and resolve operational issues.
  • Understands and interprets operational processes and business context to translate technical, clinical, financial, and operational problems into analysis, which yield insights and information to support decision making.
  • Expertise with health insurance regulatory programs and requirements, as well as associated data, including HEDIS/quality programs, risk adjustment, and utilization management.
  • Performs high value health insurance data analysis, interpretation of key business metrics, and presents insights to business leaders and key stakeholders to aid decision making and operational planning.
  • Challenges and supports business decisions with analytical rigor, insights, and judgments to drive better decisions.
  • Partners with internal Data & Analytics team to define scope, requirements, data validation, and provide prioritization input on requests and needs. Collaborates with vendors and other external parties to develop data requirements and ensures appropriate data validation and integrity.
  • Works with and contributes to data management and data governance to understand and help define data policies and standards to ensure high quality data and analytics.
  • Develops and maintains a high degree of functional, analytical, and technical acumen. Builds successful partnerships with key internal customers and cross functional teams.
  • Responsible for and performs all but the most complex assignments and work requiring independent judgment and decision making. Serves as a subject matter expert for colleagues in other functions.
  • Leads special projects and participates on workgroups and teams, as assigned.
  • Completes other duties and responsibilities as assigned.

Qualifications:
  • Education: Bachelor's degree or experience in lieu of degree
  • Experience: Six (6) years' relevant experience

Preferred Qualifications:
  • Experience in QHP/ACA and Medicare Advantage Risk Adjustment Analytics
  • Experience in MA Encounter Data Submission
  • Experience in EDGE Server Data Submission
  • Strong skills in SQL
  • Knowledge of HEDIS and Stars a plus

What's In It For You
At St. Luke's, caring for people in the communities we serve is our mission - and this includes our own SLHS team. We offer a robust benefits package to support our teams both professionally and personally. In addition to a competitive salary and retirement plans, we ensure our team feels supported in their benefits beyond the typical medical, dental, and vision offerings. We care about you and have fantastic financial and physical wellness options, such as: on-site massages, on-site counseling via our Employee Assistance Program, access to the Personify Health Wellness tool, as well as other formal training and career development offerings to ensure you are meeting your career goals.
St. Luke's is an equal opportunity employer and does not discriminate against any person on the basis of race, religion, color, gender, gender identity, sexual orientation, age, national origin, disability, veteran status, or any other status or condition protected by law.
*Please note: this posting is not reflective of all job duties and responsibilities and is intended to provide an overview to job seekers.

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