Risk Adjustment Data Analyst

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  • 19-00305
  • Direct Placement
  • Recruiting
  • El Monte, CA
Job Description
Risk Adjustment Data Analyst

El Monte, Ca

The Risk Adjustment Data Analyst is responsible for providing data reporting support to Risk Adjustment departments by analyzing, reviewing, forecasting, trend, and present information and recommendations on quality improvement activities based on HCC. The duties and responsibilities will apply to all IPAs managed by Network Medical Management.

The Data Analyst will also be assisting in special projects requested by NMM executives to include but not limited to ACO activities.


  • Analyzing data of IPA network providers, Sub IPA Groups and the entire network for Risk Adjustment Web Portal validation, reconciliation, and reporting
  • Collect and review supplemental data to ensure accuracy of documentation for reporting
  • Collect, summarize, and trend provider performance using encounter data from internal and external sources. Prepares reports, graphs, and presentation analysis to include trending.
  • Identify providers and members in need of outreach to improve outcomes low performing & high volume
  • Providing and reconciling data and analysis for Risk Adjustment gaps in care health plan and internal data
  • Create gaps in care list to ensure accuracy in member outreach efforts
  • Analyze and summarize data received from Health Plans for HCC to ensure accuracy in RAF scores, quality measure scores and provide direction for action plans
  • Plan and implement quality care improvement projects to meet health plan performance standards
  • Receive and organize data from external sources. Prepares graphs & trending reports
  • Understand the principles of HIPAA and maintain confidentiality of patient health information
  • Understand the principles of Risk Adjustment based CMS standards.
  • Communicate internally and externally as needed to gather necessary data.
  • Attend to provider and interdepartmental calls in accordance with exceptional customer service.
  • Promotes a positive working relationship between NMM, IPA’s, and health plan.
  • Attend IPA and health plan meetings as require and respond to questions/inquiries in a timely manner.
  • Performs duties in professional manner, utilizing time and resources efficiently.
  • Performs other duties, projects and actions as assigned.


  • Bachelors’ degree in Health Sciences field or Diploma/License from accredited school preferred
  • A minimum of one-year health plan, IPA or MSO experience is a plus.
  • Must value operating in a collaborative and cooperative environment
  • Ability to show initiative good judgement and resourcefulness.
  • Basic knowledge of ICE, DHCS, DMHC, NCQA, and CMS standards.
  • Excellent written and oral communication skills, as well as strong interpersonal, critical thinking and analytical skills.
  • Excellent organizational, decision-making and multi-tasking skills.
  • Excellent presentation, verbal and written communication skills and ability to collaborate with co-workers, senior leadership and other management.
  • Proven ability to prioritized and organize multi-faceted/multiple responsibilities simultaneously in a fast paced, changing environment while meeting deadlines and turnaround time requirements
  • Must be able to work independently utilizing all resources available while staying within the boundaries of duties
  • Must possess the ability to educate and train staff members and other departments as needed
  • Ability to keep a high level of confidence and discretion when dealing with sensitive matters relating to providers, members, business plans, strategies and other sensitive information is required.
  • Must be ethical and possess the ability to remain impartial and objective
  • Must be able to travel 25% of work time
  • Proficient with Microsoft Office (Word, Excel, Power Point) and EZCAP.
  • Personal & Professional Qualities
  • Punctuality, Creativity, Self-motivation
  • Professional appearance and conduct.
  • Conceptual and "big picture understanding
  • Able to function independently under time constraints
  • Willing to learn and develop new responsibilities and skills
  • Good organization, critical thinking and problem-solving skills
  • Must be detail-oriented and able to work autonomously but also as a team member
  • Should have strong communication and customer service skills and respect for confidentiality.

$22.00 – $24.00

Direct Hire


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