Job Description

STRATEGIC STAFFING SOLUTIONS (S3) HAS AN OPENING!

Strategic Staffing Solutions is currently looking for a Business Analyst for a contract opportunity with one of our largest clients located in Grand Rapids, MI!
 

Title: Risk Adjustment Business Analyst
Location: Grand Rapids, MI (hybrid/onsite 1 day per week)
Duration: 10+ Months
Role Type: W2 Contract Engagement

Engagement Description

This role requires a highly skilled Risk Adjustment Business Analyst who can bridge regulatory requirements with operational execution across Medicare Advantage and other risk-bearing programs. The analyst will help ensure compliance with CMS guidelines, minimize operational risk, and contribute to the overall success of Risk Adjustment activities by the plan.

Top Skills/Experience

• Research, interpret and understand CMS regulations and applicable laws pertaining to risk adjustment
• Collaborate with stakeholders to gather and document business requirements for risk adjustment programs, translating them into functional specifications for business teams.
• Develop and implement risk assessment and monitoring review processes to mitigate and/or remediate risk within the risk adjustment space
• Track and manage corrective action plans to address identified compliance risks and deficiencies
• Analyze existing controls and processes against guidance to enhance and strengthen those processes and controls in alignment with current guidance and best practices.
• Support the documentation, implementation and tracking of  controls and systems which create enhanced efficiency and effectiveness.

Additional Required Skills/Experience

• Data Analysis: Ability to analyze large datasets to identify trends, patterns, and anomalies related to risk adjustment and compliance.
• Using data analysis tools and software.
• Interpreting data to understand risk adjustment and compliance issues.
• Experience with BI tools and reporting platforms to create dashboards and reports for monitoring risk adjustment performance and compliance.
• Proficiency in MS Office applications
• Risk Adjustment Program Knowledge: Understanding of relevant risk adjustment programs, such as Medicare Advantage, and their specific compliance requirements.
• Regulatory Compliance: Knowledge of healthcare regulations and laws, including HIPAA, and how they apply to risk adjustment data and processes.
• Ability to analyze existing business processes, identify inefficiencies, and recommend improvements to enhance compliance and performance.

Preferred Skills/Experience

• Prior roles in a compliance and/or regulatory department

Education/Certifications

• Bachelor’s degree in healthcare administration, business, or a related field with strong quantitative and analytical coursework
• Compliance related certification, e.g., CHC, CCP would be a plus, not required

 *Beware of scams. S3 never asks for money during its onboarding process