Community First Health Plans is a leading healthcare organization dedicated to providing high-quality, affordable health insurance solutions to diverse communities. Committed to improving health outcomes, the organization leverages innovative data analytics, comprehensive care management, and collaborative partnerships to enhance patient care and operational efficiency. With a focus on member-centered services and compliance with regulatory standards, Community First Health Plans strives to be a trusted partner in health and wellness.
About The Role
The Risk Adjustment Data Analyst plays a vital role in supporting the organization’s Risk Adjustment program. This position involves analyzing healthcare data, generating detailed reports, retrieving medical records, and monitoring performance metrics to optimize risk adjustment outcomes. The analyst will coordinate with internal departments, provider networks, and external vendors to ensure accurate and timely collection and reporting of risk adjustment data. Utilizing health informatics and analytics tools, the Risk Adjustment Data Analyst identifies trends, supports Hierarchical Condition Category (HCC) capture, and ensures regulatory compliance with CMS requirements. The role also involves assisting with medical record retrieval initiatives, validating data accuracy, and analyzing provider performance to support continuous improvement initiatives.
Qualifications
- Bachelor’s degree in Health Informatics, Healthcare Administration, Data Science, or a related field (preferred)
- Minimum of two (2) years of experience in healthcare data analysis and medical record retrieval
- Experience in Risk Adjustment, managed care, health plan operations, or healthcare analytics (preferred)
- Knowledge of healthcare data systems, electronic health records (EHRs), and medical record retrieval processes
- Proficiency in Microsoft Excel and familiarity with data analytics tools such as Power BI or similar platforms
- Strong analytical, organizational, and communication skills
- Ability to collaborate effectively with providers, vendors, and cross-functional teams
- Support the organization’s Risk Adjustment program through comprehensive data analysis and reporting
- Coordinate with internal teams, provider networks, and external vendors to ensure timely collection of accurate risk adjustment data
- Utilize health informatics tools to identify trends, monitor key performance indicators, and support HCC capture initiatives
- Assist in medical record retrieval efforts, ensuring compliance with organizational and regulatory standards
- Validate data accuracy and integrity through rigorous data validation processes
- Analyze provider performance metrics and prepare actionable insights for improvement
- Support regulatory reporting requirements, including CMS submissions and audits
- Maintain up-to-date knowledge of CMS guidelines and healthcare regulations related to risk adjustment
- Collaborate with cross-functional teams to develop strategies that enhance risk adjustment outcomes and operational efficiency
- Competitive salary package
- Health, dental, and vision insurance plans
- Paid time off and holidays
- Professional development opportunities and training programs
- Retirement savings plan with employer contributions
- Flexible work arrangements, including potential remote work options
- Supportive and collaborative work environment
Community First Health Plans is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, age, disability, or any other protected status under applicable law.
