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Risk Adjustment Analyst

Company: Careerbuilder-US
Location: Melbourne
Posted on: January 20, 2023

Job Description:

Kolter Solutions is seeking a Risk ADjustment Analyst!

Location: Remote, but must reside in Florida! -

Job Description:


  • Research, develop and maintain processes for implementation of the accounting for Medicare Part C and D, including all data files from CMS, identifying procedures that will ensure compliance with CMS regulations as well as plan policies and strategies related to this function
  • Experience with ACA risk adjustment & HCC Coding
  • Maintain national standards for ICD-9-CM coding guidelines including quantity and accuracy standards. Also, maintains knowledge of the implementation of ICD-10-CM coding guidelines including quantity and accuracy standards.
  • Coordinate the MA claims encounter data/Risk Adjustment submission process.
  • Ensure compliance with CMS regulations maintaining a process for the collection, submission and reconciliation of all data.
  • Prepare the CMS monthly attestation in a timely manner ensuring that all payment discrepancies are captured and fully documented.
  • Monitor and review all communication from federal and state authorities to identify and analyze revisions or new requirements to determine impact to strategy and first-level tactical planning
  • Plan, coordinate and develop methodologies for monitoring the financial performance of the MA line of business. Develop relationships with key individuals (externally and internally) to foster an increased understanding of the financial reconciliation process


    Minimum Qualifications:
    Bachelor's degree in accounting preferred, or degree in relevant field required; or 3-5 years of related work experience or management preferred

    • Excellent verbal and written communication skills including the ability to interact professionally with all levels in the organization. Strong analytical and problem-solving abilities.
    • Ability to handle multiple tasks and meet multiple deadlines in a fast-paced, stressful environment. In order to successfully complete their job responsibilities, analysts may be permitted to work from their home while observing the current policy
    • Proficient in Microsoft Office products including Word, Excel, Access and Powerpoint. Microsoft Access preferred.


      Preferred Skills and Certifications:


      • CPC Certification


        Kolter Solutions is a leading professional staffing company based in Central Florida. We place highly skilled individuals on a contract, contract-to-hire and direct hire positions at clients nationwide.
        Kolter Solutions has proudly been recognized as the " Best Places to Work " by the Orlando Business Journal and Staffing Industry Analysts (SIA). We are also in the Fast 50 - 2020 Fastest growing companies in Central Florida !
        We offer:


        • Full Health Benefits
        • Vision
        • Dental
        • 401 (k)
        • Pet Insurance
        • Life Insurance
        • Supplemental Benefits such as short-term disability, accidental insurance, and supplemental dental and vision.
        • Employee Discounts
        • Referral Program


          Kolter Solutions is an Equal Opportunity Employer. We believe in hiring a diverse workforce and sustaining an inclusive, people-first culture. We are committed to non-discrimination on any protected basis, such as disability and veteran status, or any other basis covered under federal, state or local applicable law.

Keywords: Careerbuilder-US, Melbourne , Risk Adjustment Analyst, Professions , Melbourne, Florida

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