MogiCommunityCare
Risk Adjustment - Risk Adjustment Data Analyst II 135-2008
Full-time
About the job
JOB SUMMARY: The Risk Adjustment Analyst II supports the organization’s Medicare Advantage (MA) and Affordable Care Act (ACA) risk adjustment programs by managing data submissions, developing reporting, and delivering actionable analytics. This role is responsible for ensuring the accuracy and integrity of encounter and risk score data, including RAF (MA) and PLRS (ACA) reporting. KEY RESPONSIBILITIES: Manage Centers for Medicare & Medicaid Services (CMS) encounter submissions and ACA data processes including EDGE/PLRS reporting. Perform data validation, reconciliation, and root cause analysis to identify and resolve variances between submitted data and CMS-accepted data. Analyze submission...