Business Analyst Risk Adjustment (Healthcare Payor Domain)
Posted 5 days ago by 1750260165
Negotiable
Outside
Remote
USA
Summary: We seek an experienced Business Analyst with a strong background in Risk Adjustment within the Healthcare Payor domain. This role involves bridging the gap between business needs and technical solutions, focusing on risk adjustment, regulatory compliance, and Medicare/Medicaid programs. The position supports strategic initiatives for Elevance Health and requires deep industry knowledge along with strong analytical and communication skills.
Key Responsibilities:
- Act as a liaison between business stakeholders and technical teams to gather, analyze, and document requirements related to Risk Adjustment programs.
- Support the development, implementation, and optimization of risk adjustment models (Medicare Advantage, ACA, Medicaid).
- Collaborate with cross-functional teams to ensure alignment of project goals with regulatory and compliance standards.
- Translate business needs into functional requirements, process flows, user stories, and acceptance criteria.
- Conduct data analysis to support gap identification and improvement opportunities in risk adjustment data submissions and processes.
- Facilitate requirement review sessions and provide subject matter expertise on risk adjustment methodologies, CMS/HHS regulations, and industry best practices.
- Assist in testing efforts (UAT, SIT) to ensure delivered solutions meet business expectations.
- Provide ongoing support and recommendations for enhancements to risk adjustment platforms and workflows.
Key Skills:
- 5+ years of experience as a Business Analyst in the Healthcare Payor domain, with significant experience in Risk Adjustment.
- Deep understanding of Medicare Advantage, Medicaid, ACA, and risk adjustment regulations.
- Experience working with HCC coding, encounter data, and risk score analytics.
- Strong knowledge of CMS and HHS Risk Adjustment models.
- Ability to work effectively in a remote, cross-functional team environment.
- Proven experience in writing BRDs, FRDs, user stories, and conducting stakeholder workshops.
- Excellent verbal and written communication skills.
Salary (Rate): undetermined
City: undetermined
Country: USA
Working Arrangements: remote
IR35 Status: outside IR35
Seniority Level: undetermined
Industry: IT
Job Summary:
We seek an experienced Business Analyst with a strong background in Risk Adjustment within the Healthcare Payor domain. This role is ideal for a professional who can bridge the gap between business needs and technical solutions, specifically in projects related to risk adjustment, regulatory compliance, and Medicare/Medicaid programs. The position will support strategic initiatives for our client, Elevance Health, and requires deep industry knowledge and strong analytical and communication skills.
Key Responsibilities:
- Act as a liaison between business stakeholders and technical teams to gather, analyze, and document requirements related to Risk Adjustment programs.
- Support the development, implementation, and optimization of risk adjustment models (Medicare Advantage, ACA, Medicaid).
- Collaborate with cross-functional teams to ensure alignment of project goals with regulatory and compliance standards.
- Translate business needs into functional requirements, process flows, user stories, and acceptance criteria.
- Conduct data analysis to support gap identification and improvement opportunities in risk adjustment data submissions and processes.
- Facilitate requirement review sessions and provide subject matter expertise on risk adjustment methodologies, CMS/HHS regulations, and industry best practices.
- Assist in testing efforts (UAT, SIT) to ensure delivered solutions meet business expectations.
- Provide ongoing support and recommendations for enhancements to risk adjustment platforms and workflows.
Required Qualifications:
- 5+ years of experience as a Business Analyst in the Healthcare Payor domain, with significant experience in Risk Adjustment.
- Deep understanding of Medicare Advantage, Medicaid, ACA, and risk adjustment regulations.
- Experience working with HCC coding, encounter data, and risk score analytics.
- Strong knowledge of CMS and HHS Risk Adjustment models.
- Ability to work effectively in a remote, cross-functional team environment.
- Proven experience in writing BRDs, FRDs, user stories, and conducting stakeholder workshops.
- Excellent verbal and written communication skills.
Preferred Qualifications:
- Experience working with or for Elevance Health or similar major health insurance organizations.
- Familiarity with tools such as JIRA, Confluence, SQL, Tableau, or similar.
- Certified Business Analyst Professional (CBAP) or similar certification is a plus.
To Apply: Please submit your resume along with a brief summary of your relevant experience with Risk Adjustment projects in the healthcare payor space.