Hiring: Risk Adjustment Analyst I Company: Health Care Partners Location: Garden City, NY Job Posted Time: 2026-09-10 14:12:50 Employment Type: Full-time Target Skills & Keywords : Clinical Documentation, Medicaid, Medical Coding, Medicare, Microsoft Excel, Microsoft Office, Microsoft PowerPoint, Python, Regulatory Compliance, SQL About the job Experience: •1–3 years of experience in a healthcare setting, preferably in risk adjustment, medical coding, health plan operations, or data analytics. •Exposure to managed care, CMS audits, or healthcare data submission processes is a plus. •Operational familiarity with CMS audit processes and RADV audit procedures preferred. •Bonus Incentive: Up to 12.5% annually based on organizational performance Required Skills: •Analyze risk adjustment and claims data to identify trends, data gaps, and improvement opportunities. •Actively facilitate and support design and implementation of risk adjustment strategies across Medicare, Medicaid, Exchange, and Commercial lines of business. •Assist with internal and external audits, including RADV (Risk Adjustment Data Validation), by preparing supporting data and documentation. •Perform data quality checks and reconciliation of CMS file rejections, EDPS, RAPS, and 3M reports. •Partner with vendors to track and support chart retrieval, data validation, and documentation improvement efforts. •Partner cross-functionally with coding teams to ensure accurate and complete documentation for risk adjustment purposes. •Develop and maintain dashboards, reports, and project trackers to support operational transparency and performance monitoring. •Assist in the development and maintenance of internal policies and procedures aligned with CMS and state risk adjustment regulations. Qualifications: •Proficiency in SQL is required, including the ability to query, validate, and analyze healthcare data to support risk adjustment operations and reporting. •Strong analytical and problem-solving skills with the ability to interpret healthcare data and draw actionable insights. •Operational familiarity with Medicare Advantage risk adjustment, Medicaid risk adjustment, or ACA preferred •Monthly Membership Report (MMR), Medicare Operations Report (MOR) •RAPS Returns, EDPS reports, Plan payment reports •3M Medicaid reporting and associated metrics •Excellent organizational skills with the ability to manage multiple projects and timelines. •Effective written and verbal communication skills; ability to translate complex concepts to non-technical stakeholders. •Proficient in Microsoft Office (Excel, Word, PowerPoint); experience with data tools (Python, Tableau, SAS, or similar) is a plus. •Strong attention to detail and commitment to data integrity and compliance. Compensation: •$65,000 - $75,000 / year •The annual base salary will be determined based on factors including experience, education, posted salary range and consideration of internal equity •The base salary range for this position is listed below. The annual base salary will be determined based on factors including experience, education, posted salary range and consideration of internal equity. Interested candidates, please apply directly through the job posting on company's career page or try via AI auto apply on this platform. Don't miss this opportunity to join a forward-thinking team!