People. Passion. Purpose.
At P3 Health Partners, our promise is to guide our communities to better health, unburden clinicians, align incentives and engage patients. We are a physician-led organization relentless in our mission to overcome all obstacles by positively disrupting the business of health care, transforming it from sickness care into wellness guidance. If you are passionate about your work; eager to have fun; and motivated to be part of a fast-growing organization, then you should consider joining our team.
Overall Purpose
The primary role of the Risk Adjustment Encounter Analyst (RAA) will be to function as the encounter SME for P3. The RAA implements data analytic reports, as well as analyzes and researches data errors and issues related to CMS submissions. This requires collaboration with internal departments to work toward error resolution and risk outcome improvement. The RAA will own the encounter adjustment workflow associated with regulatory retrospective chart review efforts. The RAA will be responsible for the monitoring and management of the end-to-end data follow of data submissions to vendors and government agencies to mitigate data leakage. This includes identifying root cause and mitigation efforts. The RAA will review and apply all related regulatory requirements to department activities, i.e. audits, changes in rate models, changes in submissions, etc.
The position will also be responsible for the direction and completion of other ad-hoc projects; including data oversight and analyses as needed. The RAA must be a team player with great problem-solving skills and the ability to prioritize deadlines as appropriate.
Essential Functions
- Analyze, prioritize & support resolution of Claims/ Encounter data errors by triaging to the appropriate internal departments for a resolution, and/or work with encounter submissions vendor for resolution
- Work with the Director and Market Risk Adjustment Analysts on monthly operational and performance reporting and dashboards
- Monitor and manage end-to-end data submissions to vendors and government agencies for assigned populations to mitigate data leakage and/or submission errors.
- Cross-train to handle similar tasks across all lines of business
Knowledge, Skills, and Abilities
- Basic to intermediate skill level with Microsoft Excel, SQL & Power Point
- Ability to problem solve
Experience
- Strong claims processing skill, understanding of medical terminology, and familiarity with medical records
- Basic Data Warehouse knowledge and experience with Microsoft SQL
- Strong communication and strong written skills
- Working knowledge of the provider-based healthcare industry, claims processing, provider billing or Risk Adjustment or Medicare Advantage strongly preferred
Education
- BA or BS - Mathematics, Finance, Economics, Management, other
Work Location & Schedule
This role offers either a hybrid or fully remote work arrangement. Candidates within a 50-mile radius of a company office will follow our hybrid schedule, working on-site three days per week. Candidates located outside this radius will work remotely, with occasional travel to offices for meetings or key events.
Pay Range: $80,000 - 90,000 depending on experience
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.
