Risk Adjustment Analyst

Job Summary

To support the Medicare revenue cycle for PACE programs, the full-time Risk Adjustment Analyst will assess client needs, monitor payment data, and collaborate with financial teams while working remotely.

Key responsibilities

• Completes assessments for assigned PACE programs using CMS returns files and analytics from various Capstone departments
• Develops action plans based on structured assessments and maintains strong client relationships
• Provides training and support to clients in navigating service offerings and ensures customer satisfaction by resolving issues

Required qualifications

• Associate Degree required; B.S, B.A., or B.S.N preferred
• Minimum three years of experience in Hierarchical Condition Categories (HCC) or risk adjustment
• Experience with Risk Adjustment Analytics strongly preferred
• Knowledge of CMS Medicare revenue cycle and risk adjustment payment model preferred
• Proficient with MS Word, Excel, and PowerPoint