Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.
What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.
If you share our passion for changing healthcare so all people can live healthy, brighter lives – apply to join our team.
SCOPE OF ROLE
The Bright Health Risk Adjustment and Coding team is an integral component of Bright’s success as it defines and ensures outstanding clinical care for our members. As a Risk Adjustment Analyst focused on risk adjustment vendor management, strategy, and operations, you will be responsible for helping execute the day-to-day operations for current vendors and risk adjustment initiatives, measuring performance against service level agreements, facilitating new plan year readiness, and day-to-day facilitation of issue remediation. This role works across departments, teams, project development offices, and lines of business to deliver a best in class business results under strict regulatory adherence and compliance mindset.
The Risk Adjustment Analyst role responsibilities include, but it is not limited to these items.
- Helps lead vendor relationship and discussion as applied to contractual agreements
- Assist with vendor partnership, data transfer, and ROI calculations
- Finds, communicates, and escalates root causes and ad hoc nuances
- Shares risk adjustment vendor related metrics with leadership teams on a cyclical basis
- Assists with, tracks, and helps implement risk adjustment related initiatives and strategies
- Seeks, maintains, and builds a best a class vendor knowledge-base
- Relentlessly champions the importance of successful vendor economics through the lens of payer value
- Authors and updates policies, procedures, and program guides
- Leads annual readiness by ensuring proper setup of new products in vendor systems
- Follows, reports, and adheres to all regulatory guidance
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- Bachelor’s degree in business or related field or three years of relevant experience in lieu of degree
- Proficient in Microsoft Office Products; Word, Excel, PowerPoint
- Knowledge of Medicare Advantage and/or commercial risk adjustment models, functions, and/or strategies
- One or more years’ experience in Medicare Advantage or Commercial risk adjustment
- Business analysis experience preferably in a healthcare setting
- Experience working within a health plan risk adjustment department and/or vendor in the risk adjustment space
- Advanced skills in Microsoft Office Products; Word, Excel, PowerPoint
- Intermediate proficiency in SQL, SAS, and/or other data aggregation platforms
- Strong written and verbal communication skills
- Strong attention to detail
- Ability to quickly learn and adapt to meet business needs
- Experience working with Risk Adjustment vendors
- Demonstrated knowledge of risk adjustment regulations
- Ability to work independently
- Ability to build relationships with office staff, physicians, and market team
- This position can be completely remote.
- Travel may be required.
We’re Making Healthcare Right. Together.
We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.