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Junior Data Analyst

Junior Data Analyst

OpenkyberCA, United States
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Role : IT Coding Analyst (RADV)

Client is seeking a IT Coding Analyst (RADV) with a Camarillo CA-based client to join their team

Job Description

The IT Coding Analyst RADV plays a vital role in optimizing revenue performance through accurate coding and risk adjustment practices. This role requires a strong background in financial analysis, medical coding, and regulatory compliance within the Medicare Advantage or Medicaid environments. You'll collaborate with cross-functional teams to improve documentation, analyze coding data, support audits, and contribute to financial modeling that aligns with CMS and HHS requirements.

Key Responsibilities :

  • Financial Analysis & Risk Adjustment Modeling
  • Analyze financial data related to Medicare Advantage and Medicaid risk adjustment revenue.
  • Model revenue impact based on member risk scores (e.g., HCC, RxHCC) and coding accuracy.
  • Develop accrual estimates for financial reporting and forecasting tied to risk adjustment performance.

Coding Audits & Documentation Review

  • Audit ICD-10-CM codes for compliance with CMS-HCC and HHS-HCC models.
  • Identify and correct gaps or inaccuracies in coding and documentation.
  • Collaborate with coding and clinical teams to ensure accurate submissions.
  • Compliance & Regulatory Support

  • Ensure alignment with CMS, RADV, and HHS regulations for risk adjustment.
  • Support internal and external audits by providing detailed documentation and financial justifications.
  • Stay updated on evolving risk adjustment policies and coding guidelines.
  • Cross-Functional Collaboration

  • Work with providers to assess the financial impact of documentation practices.
  • Partner with teams such as actuarial, clinical, and compliance to align goals.
  • Generate reports on risk scores, coding trends, and financial performance for senior leadership.
  • Data & Reporting

  • Support development of tools to monitor risk adjustment metrics.
  • Collaborate with data analytics teams to improve reporting platforms.
  • Qualifications : Required :

  • Bachelor's degree in Finance, Accounting, Health Information Management, or related field.
  • 3 5 years of experience in financial analysis, risk adjustment, or medical coding in a health plan or managed care setting.
  • Strong knowledge of CMS-HCC, HHS-HCC, and RADV processes.
  • Proficient in Excel and financial modeling.
  • Understanding of ICD-10-CM coding guidelines and risk adjustment methodologies.
  • Strong analytical, communication, and presentation skills.
  • Preferred

  • Certified Professional Coder (CPC) or Certified Risk Adjustment Coder (CRC).
  • Advanced degree or certification (MBA, CFA, etc.).
  • Familiarity with Medi-Cal, Medicare Advantage, and risk adjustment data submission platforms.
  • Experience supporting audits and working in compliance-heavy environments.
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