Risk Adjustment Analyst

About Company:

PCC Medical Holding, LLC (Physician Care Centers) is a dynamic and fast-growing company of primary medical offices throughout the country. Specializing in family medicine and the Medicare population, we have grown to more than 50 clinics, 90 providers, and 500 employees spanning Florida, Georgia, South Carolina and Texas. Our goal is to guide our patients to healthy and enjoyable lives.

Our culture is to be intentionally kind to one another by treating each other with respect and empathy. The most impactful leadership lessons are taught by example. In leading, teaching, and coaching our organization to demonstrate the care, tolerance, and respect we want to see, we lead by example throughout our organization.

About the Role:

The Risk Adjustment Analyst plays a critical role in ensuring the accuracy and integrity of healthcare data used for risk adjustment and reimbursement purposes. This position involves analyzing patient data, identifying coding gaps, and collaborating with clinical and coding teams to optimize risk scores. The analyst will be responsible for interpreting complex healthcare regulations and guidelines to ensure compliance and maximize revenue capture. By leveraging data analytics and reporting tools, the Risk Adjustment Analyst supports strategic decision-making and continuous improvement initiatives. Ultimately, this role contributes to the financial health of the organization while promoting high-quality patient care through accurate documentation and coding.

Minimum Qualifications:

• Bachelor's degree in Health Information Management, Public Health, Business, or a related field.
• Experience working with healthcare data, medical coding, or risk adjustment processes.
• Strong knowledge of ICD-10-CM coding and healthcare reimbursement methodologies.
• Proficiency in data analysis tools such as Excel, SQL, or similar software.
• Excellent communication skills with the ability to collaborate across multidisciplinary teams.

Preferred Qualifications:

• Certified Risk Adjustment Coder (CRC) or Certified Professional Coder (CPC) credential.
• Experience with risk adjustment software platforms and electronic health record (EHR) systems.
• Familiarity with CMS guidelines and Medicare Advantage risk adjustment models.
• Advanced skills in data visualization tools such as Tableau or Power BI.
• Prior experience in a healthcare payer or provider setting focused on risk adjustment.

Responsibilities:

• Analyze patient medical records and claims data to identify risk adjustment opportunities and coding discrepancies.
• Collaborate with clinical, coding, and compliance teams to ensure accurate documentation and coding practices.
• Monitor and interpret regulatory changes related to risk adjustment and healthcare reimbursement.
• Develop and maintain reports and dashboards to track risk scores, coding accuracy, and financial impact.
• Provide training and support to internal teams on risk adjustment methodologies and best practices.
• Conduct audits and quality reviews to ensure data integrity and compliance with industry standards.
• Communicate findings and recommendations to leadership to support strategic initiatives and operational improvements.

Skills:

The Risk Adjustment Analyst utilizes analytical skills daily to interpret complex healthcare data and identify coding opportunities that impact reimbursement. Strong attention to detail is essential when reviewing medical records and claims to ensure accuracy and compliance with regulatory standards. Communication skills are critical for effectively collaborating with clinical and coding teams and for delivering clear reports and training sessions. Proficiency in data analysis and visualization tools enables the analyst to create actionable insights and support data-driven decision-making. Additionally, knowledge of healthcare regulations and coding standards guides the analyst in maintaining compliance and optimizing financial outcomes.

Remote Position

Work Hours

Monday- Friday

8am-5pm

1/HR Break