Internship Hcc Risk Adjustment Coder Jobs in Cumming, GA

Senior Medical Economics Analyst

Enlace Health is a specialty value-based care company focused on reducing the cost of care where it matters most: specialty services. Enlace operates across 80+ markets, delivering measurable results including millions in savings and improved care coordination. Our platform embeds actionable intelligence into real-world execution, helping payors lower medical loss ratios and drive sustainable financial performance.

At Enlace Health, our people are our greatest asset. Our culture is founded upon integrity, hard work, and the relentless pursuit to make a difference. We think creatively, we like a challenge and draw inspiration from each other. As the Senior Medical Economics Analyst, you'll have deep expertise in actuarial methods, value-based payment modeling, predictive analytics, and medical cost economics. This role will support the design, evaluation, and optimization of value-based pricing and performance frameworks across Commercial, Medicare (including Medicare Advantage), and Medicaid populations.

Success Measures: 

• In 3 months: 
• Gain full command of data and methodologies.
• Deliver early validated insights that build stakeholder confidence.

In 6 months:

• Translate analytics into actionable financial and clinical insights.
• Own development of methodologies for program evaluation, performance normalization, and predictive insights.

In 12 months:

• Architect scalable value-based pricing and performance frameworks.
• Inform network, contracting, clinical, and financial decisions with advanced analytics.
• Demonstrate measurable enterprise impact on cost, quality, and risk performance.

Responsibilities:

• Support pricing validation, reconciliation modeling, and performance evaluation analyses
• Construct prospective and retrospective target-setting methodologies using difference-in-differences approaches, market benchmarking, credibility weighting, and risk-adjusted baselines
• Evaluate financial and quality performance across Commercial, Medicare Advantage, and Medicaid lines of business
• Develop and operationalize predictive models for cost, utilization, quality outcomes, and performance evaluation
• Support steerage, network optimization, and care management analytics
• Perform medical cost trend decomposition (unit cost vs. utilization vs. intensity vs. mix)
• Conduct risk-adjusted PMPM analysis across specialties, site-of-service, and population segments
• Analyze longitudinal performance across defined assessment periods
• Quantify impact of specialty utilization patterns and referral dynamics
• Evaluating acuity, case-mix, and coding impacts across populations
• Write advanced SQL queries to construct episode-level, provider-level, and member-month datasets

Position Requirements:

• Bachelor's degree in a STEM field, with Master's degree preferred, or equivalent work experience
• 5+ years of experience working within a payer or provider organization, or with healthcare analytics or care management organizations
• Demonstrated experience across Commercial, Medicare (including MA), and Medicaid populations
• Deep experience working the following types of data:
• Medical claims data
• Enrollment and eligibility data
• Provider data
• CMS revenue and risk adjustment data
• Value-based performance datasets
• Strong proficiency in SQL, Tableau, and Excel
• Experience utilizing Python or R is a plus

Position Perks:

Enlace Health offers competitive benefits and perks to all our employees! Our comprehensive benefits package is one of the many ways we show our employees how valued they are. All full-time employees are eligible for the following:

• FREE medical, dental, and vision insurance for employees on select plans
• $1740 annual contribution into qualifying HSAs
• UNLIMITED time off
• Matching 401(k) plan
• Mac laptop and accessories
• Company-paid short-term and long-term disability
• Company-paid life insurance
• Employee Assistance Program
• Annual professional development stipend

All employees are required to maintain confidentiality as related to patient information. Employees are required to follow the acceptable use policy while using any information systems owned or controlled by Enlace. Any disclosures of confidential information made unlawfully outside the proper course of duty will be treated as a serious disciplinary offense. Security roles and responsibilities include:

• Implementing and acting in accordance with the organization's information security policies
• Protecting assets from unauthorized access, disclosure, modification, destruction, or interference
• Executing particular security processes or activities
• Ensuring responsibility is assigned to the individual for actions taken
• Reporting security events or potential events or other security risks to the organization

The above statements are intended to describe the general nature and level of work being performed by people assigned to this position. The requirements listed above are representative of the minimum knowledge, skill, and/or ability required. To perform this job successfully, an individual must be able to satisfactorily perform the essential functions of the job according to specific company requirements. Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions. Qualified applicants will be afforded equal employment opportunities without discrimination because of race, creed, color, national origin, sex, disability, or marital status. Applicants must be legally authorized to work in the US.