Hcc Risk Adjustment Analyst Jobs in Raleigh, NC (NOW HIRING)

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Duke Health Integrated Practice

Duke Health Integrated Practice comprises more than 110 primary and specialty outpatient clinics, extending the reach of the Duke Health mission across the state of North Carolina.

DHIP Administrative Offices RTP - 4825 Creekstone Dr

Reporting to the DHIP Associate Vice President for Clinical Planning and Growth and working in partnership with the DHIP Chief Financial Officer, DHIP Community Chief Medical Officer, and DHIP VP of Operations, DHIP Network Management Directors this position works directly with the Community DHIP network, practices, physicians and practice leadership. Quality Program Specialist is an individual contributor responsible for supporting the execution and performance of system wide value-based care programs, including bundled payments, shared savings contracts, and quality gap closure initiatives. This role collaborates closely with clinical, operational, and analytics teams to monitor quality performance, identify improvement opportunities, and drive adoption of standardized workflows. The position serves as a key liaison between centralized quality functions and frontline practice teams to ensure consistent execution of strategies that improve patient outcomes and contract performance.

• Goals of role
  • Top tier performance in targeted quality measures and gap closure rates
  • Contribution to successful performance in bundled payment and shared savings programs
  • Adoption of standardized workflows across supported practices
  • Delivery of accurate, timely, and actionable reporting

Program Management - Bundled Payments

• Supports implementation and ongoing management of bundled payment programs across targeted service lines
• Monitors performance metrics, including cost, utilization, and quality outcomes
• Works with clinical and operational teams to align workflows with bundle requirements and improve episode performance
• Support quality based contract negotiations

Shared Savings Contract Support

• Tracks performance against shared savings contracts, including Medicare and commercial value-based arrangements
• Partners with operations, finance and analytics teams to identify drivers of cost and quality performance
• Translates contract quality metrics into actionable plans for practices and providers
• Identifies risks to performance and supports mitigation strategies
• Work with coding and clinical to appropriately communicate risk level of patient using HCC risk coding guidelines

Clinical Gap Closure

• Leads initiatives to improve quality performance, including HEDIS and Star Ratings measures
• Supports practice-level strategies for clinical gap closure (e.g., preventive screenings, chronic disease management, annual wellness visits)
• Collaborates with care teams and outreach functions to improve patient engagement and completion of care gaps

Data Analysis & Reporting *

• Analyzes performance data to identify trends, variation, and opportunities for improvement
• Prepares structured reports and executive-level summaries highlighting key insights and recommended actions
• Supports internal and external reporting requirements related to quality and value-based contracts

Clinical & Operational Engagement *

• Serves as a liaison between quality, operations, and clinical teams
• Provides education and guidance on quality measures, documentation, and workflow expectations
• Participates in performance reviews with practices and contributes to action planning
• Connect with patients as needed to support continuity of care measures. Flag and support high risk patients for clinical intervention

Process Improvement & Standardization

• Identifies opportunities to standardize quality workflows across practices
• Analyses and recommendation for new program development. Provide implementation support for new programs based on a data driven strategy
• Supports development and implementation of SOPs related to:
  • Gap closure workflows o
  • Bundle program operations
  • Documentation and coding practices
• Collaborates with IT/EMR teams to optimize systems supporting quality measurement and reporting
• Work with leadership teams throughout the Health System, serving as a resource to help reduce costs, enhance revenues, achieve effective utilization and quality goals and objectives, analyze and utilize information to develop and support management decisions.

Education

• Bachelor's Degree
  • A Master's Degree in Business Administration, Health Administration or related field is preferred

Experience

• Minimum of 3-5 years of experience in healthcare quality, population health, or value-based care programs
• Experience in an integrated delivery system or large physician enterprise
• Familiarity with EMR reporting tools (Epic)
• Demonstrated understanding of HCC coding
• Lean or Six Sigma certification preferred
• Healthcare coaching certification or experience preferred

The schedule for this position is day shifts, Monday-Friday, with no weekends or holidays.

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Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.