Senior Risk Adjustment Business Analyst

Overview :

TekWissen is a global workforce management provider headquartered in Ann Arbor, Michigan that offers strategic talent solutions tour clients world-wide. Our client is a health insurance company. It offers different types of health care coverage plans that include individual and family, dental and vision, plans for employers, etc.

Title: Senior Risk Adjustment Business Analyst

Work Location: Grand Rapids, MI

Duration: 10+ Months

Job Type: Temporary Assignment

Work Type: Hybrid

Dept: SHS Risk Management-EH

Engagement Description:

• This engagement requires a highly skilled Risk Adjustment Business Analyst whcan bridge regulatory requirements with operational execution across Medicare Advantage and other risk-bearing programs.

• The analyst will help ensure compliance with CMS guidelines, minimize operational risk, and contribute tthe overall success of Risk Adjustment activities by the plan.

• The ideal candidate will bring a strong foundation in risk adjustment), reviewing and translating regulatory requirements and helping the business area implement compliant and optimal solutions. Additionally, the Business Analyst will support industry level research tensure that best practices are implemented that minimize risk, while maximizing health outcomes for the organization's members.

• Success in this role demands cross-functional collaboration, critical thinking, and the ability toperate in a fast-paced, high-stakes environment. This engagement directly supports our organization's ability tremain compliant, optimize RAF accuracy, and achieve sustainable reimbursement outcomes.

Top 3 Required Skills/Experience

Business Requirements Gathering:

• They research, interpret and understand CMS regulations and applicable laws pertaining trisk adjustment

• They collaborate with stakeholders tgather and document business requirements for risk adjustment programs, translating them intfunctional specifications for business teams.

Risk Management

• They develop and implement risk assessment and monitoring review processes tmitigate and/or remediate risk within the risk adjustment space

• They track and manage corrective action plans taddress identified compliance risks and deficiencies

Process Improvement:

• They analyze existing controls and processes against guidance tenhance and strengthen those processes and controls in alignment with current guidance and best practices.

• They support the documentation, implementation and tracking of controls and systems which create enhanced efficiency and effectiveness.

Required Skills/Experience The rest of the required skills/experience. Include:

Technical Skills:

• Data Analysis: Ability tanalyze large datasets tidentify trends, patterns, and anomalies related trisk adjustment and compliance. This includes:

• Using data analysis tools and software.

• Interpreting data tunderstand risk adjustment and compliance issues.

• Business Intelligence (BI) and Reporting: Experience with BI tools and reporting platforms tcreate dashboards and reports for monitoring risk adjustment performance and compliance.

• Proficiency in MS Office applications

Business Skills:

• Risk Adjustment Program Knowledge: Understanding of relevant risk adjustment programs, such as Medicare Advantage, and their specific compliance requirements.

• Regulatory Compliance: Knowledge of healthcare regulations and laws, including HIPAA, and how they apply trisk adjustment data and processes.

• Business Process Analysis: Ability tanalyze existing business processes, identify inefficiencies, and recommend improvements tenhance compliance and performance.

• Problem-solving: Ability tidentify and assist with resolving complex compliance issues related trisk adjustment data and processes.

• Communication: Excellent verbal and written communication skills teffectively communicate with internal teams, external partners, and regulatory bodies.

• Attention tDetail: Meticulous attention tdetail tensure accuracy and compliance in data and processes.

• Research: Ability treview conduct research and review of regulatory guidance tinterpret and implement.

• Project Management: Ability tmanage projects related trisk adjustment initiatives and compliance projects, requiring skills like defining scope, identifying resources, and scheduling.

• Stakeholder Management: Ability tcollaborate effectively with various stakeholders, including clinical staff, IT teams, and management.

• Critical Thinking and Decision-Making: Ability tanalyze situations, make informed decisions, and develop solutions tcomplex problems.

• Adaptability: Ability tadapt tchanges in regulations and risk adjustment programs.

Preferred Skills/Experience Optional but preferred skills/experience. Include:

• Prior roles in a compliance and/or regulatory department

Education/Certifications Include:

• Bachelor's degree in healthcare administration, business, or a related field with strong quantitative and analytical coursework

• Compliance related certification, e.g., CHC, CCP would be a plus, not required

TekWissen Group is an equal opportunity employer supporting workforce diversity.