|
We are recruiting for a motivated Risk Adjustment Analyst - Denver Health Medical Plan (*Must Be A Colorado Resident) to join our team!
We are here for life's journey.
Where is your life journey taking you?
Being the heartbeat of Denver means our heart reflects something bigger than ourselves, something that connects us all:
Humanity in action, Triumph in hardship, Transformation in health. Department Managed Care Administration
*Must Be A Colorado Resident Job Summary
The Risk Adjustment Analyst will support DHMP's Medicare Advantage and ACA Marketplace lines of business. This position plays a key role in supporting risk adjustment strategy, resolving EDGE submission issues, coordinating with vendors, and ensuring data quality and regulatory compliance.
Essential Functions:
- Develop and maintain complex SQL queries, stored procedures, and data models to extract and analyze claims, encounter, and clinical data for Medicare Advantage and ACA Marketplace populations (20%)
- Create advanced data mining algorithms and targeting models to identify risk adjustment opportunities, coding gaps, and high-impact member-level interventions (20%)
- Investigate and help resolve EDGE server rejections to ensure completeness and accuracy of data submissions performed by external vendors (20%)
- Prepare quarterly and annual reports for senior leadership, including risk adjustment performance, operational metrics, and regulatory insights (20%)
- Apply deep knowledge of ACA and CMS-HCC/CMS-RxHCC risk adjustment methodologies, including coefficient updates and risk score calculations (15%)
- Develop and maintain executive dashboards and reports that track KPIs such as risk score trends, provider performance, coding velocity, and financial outcomes (5%)
Education:
- Bachelor's Degree Economics, Statistics, Actuarial Science, Public Health, Mathematics, or a related quantitative field required
Work Experience:
- 3-5 years of health insurance or healthcare analytics experience across Medicare Advantage and ACA products required and
- 2+ years of direct, hands-on experience with ACA and Medicare Advantage risk adjustment programs required
Licenses:
Knowledge, Skills and Abilities:
- Strong data analysis skills and advanced SQL proficiency
- Experience researching and resolving EDGE submission rejections
- Strong written and verbal communication skills
Shift Days (United States of America)
Work Type Regular
Salary $82,400.00 - $127,600.00 / yr
Benefits
Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans Free RTD EcoPass (public transportation) On-site employee fitness center and wellness classes Childcare discount programs & exclusive perks on large brands, travel, and more Tuition reimbursement & assistance Education & development opportunities including career pathways and coaching Professional clinical advancement program & shared governance Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer
Our Values
Respect Belonging Accountability Transparency
All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.
Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver's 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation.
As Colorado's primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year.
Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.
Denver Health is an equal opportunity employer (EOE). We value the unique ideas, talents and contributions reflective of the needs of our community. Applicants will be considered until the position is filled.
|
Denver Health
tuition reimbursement, retirement plan
Sep 12, 2025