Senior Analyst, Risk Adjustment Data Integrity & Payor Submissions
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What you'll do
- High-volume manipulation of complex data files (formatting pipe | and tilde ~ delimiters, checking Tax IDs, member identifiers, and ICD-10 codes) across various health plan templates.
- Autonomously manages the recurring Alternate Submission Methodology (ASM) sweeps calendar, CMS deadline runs, and sFTP transmissions.
- Serves as the primary operational link between Team Helix, Gemini /TopLine, ROPS, IT, and external payor risk adjustment teams.
What they're looking for
- Bachelor’s degree in Healthcare Administration, Health Informatics, Data Analytics, Finance, Computer Science, Business, or a related field (or equivalent practical experience)
- 2–4+ years of relevant experience in healthcare data analysis, claims operations, risk adjustment, or billing/EDI operations
- Advanced Excel Proficiency: High comfort manipulating large, multi-thousand-row datasets without errors (complex formulas, nested logic, text manipulation, pivot tables, and generating delimited text files such as pipe | and tilde ~).
- Data Querying & SQL: Working knowledge of SQL and relational database schemas to inspect data extracts, query missing values, and validate tables against source systems.
- File Transmission & Portals: Hands-on experience with secure file transfer protocols (sFTP) and secure health plan web portals.
- EHR & Billing Systems: Familiarity with Electronic Health Record (EHR) and Practice Management platforms (NextGen, Cerner, or Epic).
- Medicare Advantage & Risk Adjustment (MRA): Understanding of CMS Risk Adjustment concepts, Hierarchical Condition Categories (HCCs), and CMS sweeps/submission cycles
- EDI Standards & Return Files: Familiarity with EDI 837 encounter files, 835 payment/remittance files, 999 acknowledgments, and CMS MAO-004 response files
- Data Quality & Reconciliation: Demonstrated ability to perform root-cause analysis on claim denials, data discrepancies (e.g., mismatched subscriber IDs, invalid TINs, missing DOS), and unbilled/rebill workflows
Nice to have
- Prior experience working within a Medicare Advantage health plan, MSO, or value-based clinical organization (e.g., IKC / ACO).
- Health Information certifications (e.g., RHIA, RHIT).
- Experience with business intelligence / visualization tools (Tableau, Power BI) for executive MOR and JOC reporting
- Experience supporting EHR or data platform migrations
Summarised by NextRaise from the employer’s description, which follows in full below.
Full description from employer
Posting Date
09/14/20267360 Engle Rd, Middleburg Heights, Ohio, 44130-3429, United States of AmericaSenior Analyst, Risk Adjustment Data Integrity & Payor Submissions
This Senior Analyst role would join the Integrated Kidney Care (IKC) Model of Care team working on the Comprehensive Health Evaluation (CHE) program, with a focus on encounter data submissions. By strengthening execution of complex payor submissions, improving data integrity, and performing against CMS encounter reconciliation deadlines, this person would help drive the performance of our risk adjustment programs, with an emphasis on compliance. The right candidate has experience in Alternative Submission Methodologies (ASM), CMS submission calendars, and Medicare Risk Adjustment.
Qualifications:
- Bachelor’s degree in Healthcare Administration, Health Informatics, Data Analytics, Finance, Computer Science, Business, or a related field (or equivalent practical experience)
- 2–4+ years of relevant experience in healthcare data analysis, claims operations, risk adjustment, or billing/EDI operations
Technical skills:
- Advanced Excel Proficiency: High comfort manipulating large, multi-thousand-row datasets without errors (complex formulas, nested logic, text manipulation, pivot tables, and generating delimited text files such as pipe | and tilde ~).
- Data Querying & SQL: Working knowledge of SQL and relational database schemas to inspect data extracts, query missing values, and validate tables against source systems.
- File Transmission & Portals: Hands-on experience with secure file transfer protocols (sFTP) and secure health plan web portals.
- EHR & Billing Systems: Familiarity with Electronic Health Record (EHR) and Practice Management platforms (NextGen, Cerner, or Epic).
Industry knowledge:
- Medicare Advantage & Risk Adjustment (MRA): Understanding of CMS Risk Adjustment concepts, Hierarchical Condition Categories (HCCs), and CMS sweeps/submission cycles
- EDI Standards & Return Files: Familiarity with EDI 837 encounter files, 835 payment/remittance files, 999 acknowledgments, and CMS MAO-004 response files
- Data Quality & Reconciliation: Demonstrated ability to perform root-cause analysis on claim denials, data discrepancies (e.g., mismatched subscriber IDs, invalid TINs, missing DOS), and unbilled/rebill workflows
Nice to have, but not necessary:
- Prior experience working within a Medicare Advantage health plan, MSO, or value-based clinical organization (e.g., IKC / ACO).
- Health Information certifications (e.g., RHIA, RHIT).
- Experience with business intelligence / visualization tools (Tableau, Power BI) for executive MOR and JOC reporting
- Experience supporting EHR or data platform migrations
High-level responsibilities include:
- High-volume manipulation of complex data files (formatting pipe \| and tilde ~ delimiters, checking Tax IDs, member identifiers, and ICD-10 codes) across various health plan templates.
- Autonomously manages the recurring Alternate Submission Methodology (ASM) sweeps calendar, CMS deadline runs, and sFTP transmissions.
- Serves as the primary operational link between Team Helix, Gemini /TopLine, ROPS, IT, and external payor risk adjustment teams.
#LI-EO1
At DaVita, we strive to be a community first and a company second. We want all teammates to experience DaVita as "a place where I belong." Our goal is to embed belonging into everything we do in our Village, so that it becomes part of who we are. We are proud to be an equal opportunity workplace and comply with state and federal affirmative action requirements. Individuals are recruited, hired, assigned and promoted without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, protected veteran status, or any other protected characteristic.
This position will be open for a minimum of three days.
The Salary Range for the role is $62,000.00 - $95,000.00 per year.
If a candidate is hired, they will be paid at least the minimum wage according to their geographical jurisdiction and the exemption status for the position.New York Exempt: New York City and Long Island: $66,300.00/year, Nassau, Suffolk, and Westchester counties: $66,300.00/year, Remainder of New York state: $62,353.20/year New York Non-exempt: New York City and Long Island: $17.00/hour, Nassau, Suffolk, and Westchester counties: $17.00/hour, Remainder of New York state: $16.00/hourWashington Exempt: $80,168.40/year Washington Non-exempt: Bellingham: $19.13/hour, Burien: $21.71/hour, Everette: $20.77/hour, Unincorporated King County: $20.82/hour, Renton: $21.57/hour, Seattle: $21.30/hour, Tukwila: $21.65/hour, Remainder of Washington state: $17.13/hour
For location-specific minimum wage details, see the following link: DaVita.jobs/WageRates
Compensation for the role will depend on a number of factors, including a candidate’s qualifications, skills, competencies and experience. DaVita offers a competitive total rewards package, which includes a 401k match, healthcare coverage and a broad range of other benefits. Learn more at https://careers.davita.com/benefits
Colorado Residents: Please do not respond to any questions in this initial application that may seek age-identifying information such as age, date of birth, or dates of school attendance or graduation. You may also redact this information from any materials you submit during the application process. You will not be penalized for redacting or removing this information.
Company
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