Risk Adjustment Analyst

COMPANY OVERVIEW

Zing Health is a tech-enabled insurance company making Medicare Advantage the best it can be for those 65 and over. Zing Health has a community-based approach that recognizes the importance of the social determinants of health in keeping individuals and communities healthy. Zing Health aims to return the physician and the member to the center of the healthcare equation. Members receive individualized assistance to make their transition to Zing Health as easy as possible. Zing Health offers members the ability to personalize their plans, access to facilities designed to help them better meet their healthcare needs, and a dedicated care team. For more information on Zing Health, visit www.myzinghealth.com.

SUMMARY DESCRIPTION:

The Risk Adjustment Analyst position is responsible for supporting strategic program and project design, execution, and performance management of initiatives supporting Quality Improvement and the Star Rating measurement system established by the Centers for Medicare and Medicaid Services (CMS). The Risk Adjustment Analys collaborates across a matrixed organization and is responsible for coordinating efforts across multiple domains and functional workgroups that impact Zing Health’s Medicare Star ratings. This role will leverage project management skills and discipline across a strategic playbook of interventions, campaigns, and initiatives and may involve participating in activities including, but not limited to, market research, competitive analysis, content review and development, partnership with third-party print and engagement solutions, vendor engagement and management, reporting, and presentation development. This role interacts with and plays a key role in collaborating with all departments at Zing Health.

ESSENTIAL FUNCTIONS:

• Effectively manage projects from inception to performance management
• Manage the Medicare Risk submissions lifecycle and third-party relationships
• Lead ad hoc analyses to identify issues, data trends, and investigate discrepancies in data submissions
• Develop, deliver, and performance manage provider insights for essential Risk-relevant initiatives related to HCC accuracy, recapture, and successful submission
• Provide insightful analysis to solve business problems as they arise
• Synthesize concepts and/or requests into actionable tasks
• Serve as primary liaison in establishing, enacting, and performing all control reporting and reconciliation required of our submission product
• Perform root cause analysis to identify any issues in current operational processing
• Assist on special projects requested by leadership
• Provide Subject Matter Expertise within Medicare Submissions
• Provide consultative approach to clients leveraging deep knowledge of Medicare submissions, including awareness of changing industry landscape, trends, and regulations
• Serve as 837 and EDI expert, assisting clients with EDI-related file submission issues
• Demonstrate an understanding of the Medicare Star Rating program
• Effective project plan development, maintenance, and management
• Logging, tracking, and ensuring completion of all key project milestones
• Maintain a working knowledge of competitive strategies, marketing techniques, and outsourced solutions to improve Star Rating performance
• Effectively communicate across departments 
• Participate in or lead cross-departmental workgroups and committees
• Closely partner with strategic partners throughout the organization to effectively set and performance manage appropriate project/initiative related goals
• Meet with key stakeholders throughout the organization to gather, document, track, and update specific requirements of each project/intervention
• Track project / intervention performance, specifically to analyze the successful completion of the project / intervention and continuously improve project / intervention execution for subsequent measurement periods
• Communicate, as needed, with appropriate RACI stakeholders to keep projects / initiatives on track and / or aligned with organizational goals and budget
• Perform quality control on the projects / interventions throughout the project / intervention lifecycle
• Serve as a liaison for the Stars and Quality department for marketing projects including appropriate routing through compliance and CMS workflows
•  Perform other related duties as assigned.

QUALIFICATIONS AND REQUIREMENTS:

JOB REQUIREMENTS:

Required Qualifications

• Bachelor’s Degree in analytics, healthcare informatics, management, Project Management, or equivalent
• 2-3+ years of work experience in Healthcare encounter submissions, working with 837 files and EDI transactions.
• 3+ years of work experience in gathering, analyzing, and reporting on data
• Experience with the Medicare encounter submission lifecycle
• Experience working and presenting effectively with all levels of leadership, as well as business partners and staff.
• Be able to effectively manage a project plan lifecycle
• Strong communication skills both oral and written.
• Strong organizational skills, consistent attention to detail, and independent problem-solving skills
• Familiarity with Medicare Advantage and the Medicare Star Rating program, especially areas such as customer service, provider service, pharmacy, marketing, supplemental benefits, flexible spending technology, CAHPS, HOS, and HEDIS
• Ability to perform multiple tasks simultaneously, work under pressure, and meet critical deadlines.
• Must possess a high degree of professionalism and business ethics.
• Ability to work autonomously with little to no daily supervision while demonstrating continual progress and effective management of projects / interventions

Preferred Qualifications

• Experience writing complex SQL queries (joining multiple data sets)
• Familiarity with project management tools such as Jira, Trello, Smartsheet, Microsoft Project, Monday, Wrike, etc.
• Advanced knowledge of computer systems, such as Microsoft Word, PowerPoint, Excel, and Outlook.
• PMP or Lean Six Sigma certifications