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Remote Hcc Risk Adjustment Jobs in Naperville, IL

Tmhcc

Senior Talent Acquisition Advisor

Chicago, IL · On-site +1

$93K - $154K/yr

Tokio Marine HCC (TMHCC) brings 50 years of service to the specialty insurance industry, today ... adjustments, where applicable. The pay range is the range THMCC, in good faith, believes is the ...

Archgroup

AVP, Construction

Chicago, IL · On-site +1

$150K - $190K/yr

The team is open to discussing hybrid or remote options in Minneapolis, Chicago, and St. Louis ... Assesses insurance and related financial risk and structures appropriate loss sensitive program to ...

Archgroup

AVP, Construction

Chicago, IL · On-site +1

$150K - $190K/yr

The team is open to discussing hybrid or remote options in Minneapolis, Chicago, and St. Louis ... Assesses insurance and related financial risk and structures appropriate loss sensitive program to ...

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Remote Hcc Risk Adjustment information

What is the difference between Remote Hcc Risk Adjustment vs Remote Medical Coder?

AspectRemote Hcc Risk AdjustmentRemote Medical Coder
CertificationsHCC Certification, CPC or CCSCPC, CCS, or RHIT
Work EnvironmentHealthcare insurance, risk adjustment teamsMedical facilities, billing departments
Industry UsageHealth plans, Medicare/MedicaidHospitals, clinics, billing companies

Remote Hcc Risk Adjustment specialists focus on analyzing patient data to optimize risk scores for insurance purposes, while Remote Medical Coders translate medical records into billing codes. Both roles require healthcare certifications and involve remote work, but they serve different functions within the healthcare industry.

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Remote Hcc Risk Adjustment jobs near you

Data Systems Analyst

3B Staffing LLC

Chicago, IL • Remote

Full-time

Re-posted 16 days ago

Job description

The Data Systems Analyst leads the integration of various healthcare payer data and internal enterprise systems data into enterprise data platforms. This role is responsible for analyzing, mapping, validating, and standardizing various payer feeds including eligibility, claims, quality, and risk adjustment data, alongside internal systems such as EMR , CRM, HR etc. to maintain a reliable single source of truth supporting value based care.

The ideal candidate will combine strong healthcare data knowledge, technical expertise, a collaborative mindset, and a desire to grow within a complex and mission-driven data environment.

Essential Duties and Responsibilities

Key Responsibilities:

  • Onboarding and integration of various payer feeds, including eligibility (834 or flat files), medical and institutional claims (837 or flatfiles), HEDIS quality data, HIE, and risk adjustment and RAF related datasets
  • Analyze and map data from external payer sources and internal systems such as EMR, CRM, and operational platforms into the enterprise data model
  • Maintain source to target mappings, transformation logic, and standardized data definitions across payer and internal feeds
  • Identify payer specific variations, data quality issues, and structural differences, and support normalization within the data warehouse
  • Validate data ingestion and transformations through profiling, reconciliation, and exception analysis
  • Partner closely with data engineering and senior analysts to ensure scalable, accurate, and well documented scenario documents and ingestion pipelines
  • Serve as a subject matter expert for integrated payer and internal data, supporting analytics, reporting, and operational use cases
  • Lead discovery sessions with customers to document technical specifications, data elements, and business requirements
  • Support translation of clinical, operational, and business requirements into clear data and system specifications
  • Define and implement data quality rules and monitoring frameworks for all critical data pipelines
  • Develop and enforce data governance policies, including metadata management, lineage tracking, and compliance standards.
  • Ensure assigned integration stories are delivered on time and are fully prepared for engineering implementation

Required Qualifications

  • Bachelor's degree in Computer Science, Information Systems, or a related field, or equivalent experience
  • 4-5 years of experience in data warehousing, data integration, or business intelligence roles
  • Experience working with healthcare payer data, including experience working with 834, 837, HEDIS, pharmacy, census and RAF datasets Advanced SQL skills and strong understanding of relational database concepts
  • Deep working knowledge of enterprise data warehouse and data mart architecture
  • 1+ years of working experience with data governance frameworks and tools (e.g., Catalog, Atlan, Collibra, Alation) and data quality frameworks.
  • 2+ years of experience of cloud-based data platforms like snowflake
  • Solid SQL skills and understanding of relational database concepts
  • Familiarity with scrum/agile methodologies and tools such as Jira
  • Proven ability to support integration projects and drive agile delivery
  • Strong communication skills with the ability to collaborate across technical and non technical teams
  • Strong problem-solving skills, attention to detail, and a proactive approach to ownership
  • High level of ownership, initiative, and attention to detail

Physical and Mental Requirements

  • Ability to stand/sit for extended periods.
  • Visual acuity and fine motor skills.
  • Ability to travel as needed.

Work Environment

  • Remote
  • Travel may be required up to 15% locally or nationally

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