Data Risk Analyst

Position Overview

Based in Phoenix, AZ, the Data Risk Analyst acts as a key data and strategic specialist bridging clinical documentation with actuarial health forecasting to track health plan performance and manage financial risk. The role prioritizes full regulatory adherence while enhancing company revenue through sophisticated coding techniques and data analytics tools.

Key Responsibilities

• Compile and cleanse financial claims, pharmacy, enrollment, and premium datasets, transforming them into actionable data models.
• Evaluate diagnostic data to compute Risk Adjustment Factors (RAF) and predict financial outcomes grounded in clinical indicators.
• Ensure thorough understanding and application of medical terminologies, ICD-10-CM coding, and Hierarchical Condition Categories (HCC) to detect coding errors or uncover revenue deficiencies.
• Support audits by generating backend reports and validating data for internal quality assessments and federal Risk Adjustment Data Validation (RADV) audits.
• Collaborate cross-functionally with clinical providers to deliver Clinical Documentation Improvement (CDI) training, guaranteeing comprehensive medical charting of patient disease burdens.
• Create customized automated dashboards and ad-hoc financial planning reports that communicate risk patterns to executive management.

Required Skills and Expertise

• Advanced expertise in SQL for managing relational databases.
• Proficient in statistical modeling using Python, SAS, or R.
• Strong grasp of dimensional data modeling techniques.
• Familiarity with ICD-10-CM, HCC coding standards, and medical terminologies.

Preferred Qualifications

• Prior healthcare sector experience.
• Good understanding of data science statistics.
• Effective communication and interpersonal abilities.
• Strong analytical thinking and problem-solving skills.