ZipRecruiter

Log In

Hueman Risk Adjustment Staffing
Hueman Risk Adjustment Staffing

60 Hueman Risk Adjustment Jobs Hiring in Georgia

LCMC Health

... quality, risk adjustment, and reimbursement. * Oversee the physician query process, ensuring ... Staff leaders, Nursing, Revenue Cycle, * Compliance, and Information Technology departments to ...

Truist

Senior Capital Markets Risk Officer

Atlanta, GA · On-site

Directly and indirectly liaise with senior internal and external staff in relation to regulatory ... Adjustment 'CVA', etc.) using complex quantitative risk models. * Provide analytical direction ...

New

next page

Showing results 1-20

All JobsHueman Risk Adjustment JobsJobs at Hueman Risk Adjustment in Georgia

Business Analyst with Risk Adjustment (Payor) || 1099 only || Need USC or GC only

Pantar Solutions inc

Atlanta, GA • On-site

Contractor

Re-posted 4 days ago

Job description

We are an Information Technology and Business Consulting firm specializing in Project-based Solutions and Professional Staffing Services. Please have a look at below position which is with our Client and let me know your interest ASAP. I would really appreciate if you could send me your MOST RECENT UPDATED RESUME: 

Title: Business Analyst – Risk Adjustment (Payor)

Location: Richmond or Atlanta  – Hybrid role

Long Term Contract || 1099 only || Need USC or GC only

Need strong Business Analyst – Risk Adjustment (Payor) with  risk adjustment analytics in a healthcare payer environment (Medicare Advantage, ACA (HIX/Exchange), or Medicaid), SQL, Excel, data visualization tools (Tableau/Power BI/SAS), healthcare data formats (claims, encounters, EMR, lab, and eligibility), regulatory processes (CMS, HHS, EDGE server, RADV/IVA audits), HCC coding models (CMS-HCC, HHS-HCC), ICD-10 codes, and claims data Exp.

Consultant LinkedIn profile must have been created before 2018/2019

Need 8-10+yrs of IT Exp. Profiles

Job Summary:Client is seeking a highly analytical and motivated Business Analyst – Risk Adjustment to support risk adjustment operations and data analytics initiatives. This role is critical in helping ensure accurate and compliant capture of risk adjustment data for government-sponsored programs such as Medicare Advantage and ACA (HIX/Exchange). The candidate will play a key role in translating business needs into technical solutions, driving insights, and enabling optimized risk scoring strategies.
Key Responsibilities:

  • Analyze and interpret risk adjustment data (claims, encounters, chart reviews, HCCs) to identify trends, data quality issues, and improvement opportunities.

  • Collaborate with stakeholders across actuarial, clinical coding, IT, and compliance teams to support risk score accuracy.

  • Translate regulatory and business requirements into user stories or functional specifications for data/reporting solutions.

  • Support CMS/HHS risk adjustment submission processes including EDGE server management and encounter reconciliation.

  • Assist in development and enhancement of dashboards/reports for risk score monitoring, suspecting models, and provider performance.

  • Monitor and interpret changes in CMS/HHS risk adjustment guidelines and apply to internal business processes.

  • Participate in audit support (e.g., RADV, IVA) and validation of risk adjustment data submissions.

  • Act as liaison between technical teams and business stakeholders to ensure delivery of actionable and scalable solutions.

Qualifications:

  • Bachelor's degree in Healthcare Administration, Business, Analytics, or related field (Master’s preferred).

  • 8+ years of experience in risk adjustment analytics in a healthcare payer environment (Medicare Advantage, Medicaid, or ACA).

  • Strong knowledge of HCC models (CMS-HCC, HHS-HCC), ICD-10 coding, and risk adjustment methodologies.

  • Experience with healthcare data formats: claims, encounters, EMR, lab, and eligibility.

  • Proficiency in SQL and Excel; experience with BI tools like Power BI, Tableau, or SAS preferred.

  • Familiarity with regulatory processes (CMS, HHS, EDGE server, RADV/IVA audits).

Preferred Skills:

  • Knowledge of data and reporting tools, including Cognos or Watson Health platforms.

  • Experience in Agile environments; ability to write and manage JIRA user stories and tasks.

  • Strong communication and stakeholder engagement skills across technical and business teams.

 
Thanks & Regards,
 
Babu