As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission. EO/AA

Risk Adjustment Analyst position provides support for our health plan’s risk adjustment program. This role is responsible for analyzing medical claims, encounter, and risk adjustment targeting data to identify opportunities for accurate and complete risk score capture in ACA (Marketplace), and Medicaid populations. The position will collaborate cross-functionally with clinical, coding, and IT teams to ensure compliance, optimize risk adjustment revenue, and help drive provider engagement interventions.

Corporate Overview: University of Utah Health is an integrated academic healthcare system with five hospitals including a level 1 trauma center, eleven community health centers, over 1,600 providers, and a health plan serving over 200,000 members. University of Utah Health is nationally ranked and recognized for our academic research, quality standards and overall patient experience. In addition to our clinical delivery system, we have a School of Medicine, School of Dentistry, College of Nursing, College of Pharmacy, and College of Health providing education and training for over 1,250 providers annually. We have over 2 million patient visits annually and research grants exceeding $350 million. University of Utah Hospitals and Clinics represents our clinical operations for the larger health system.

• Performs retrospective and prospective risk adjustment analytics to drive revenue optimization and compliance.
• Monitors risk adjustment metrics, trends, and anomalies across various lines of business (e.g., ACA, Medicaid).
• Supports the evaluation of risk adjustment interventions such as provider outreach, chart reviews, and in-home assessments.
• Leverages data and predictive analysis to clearly articulate Risk Gaps and influence strategic decisions.
• Communicates key information to Compliance and Audit partners for awareness of trends, processes, and risk adjustment issues.
• Works closely with Compliance and Audit data domain leaders that share risk adjustment responsibilities.
• Develops collaborative relationships with internal partners to ensure risk adjustment goals are met.
• Analyzes the integrity of data, diagnose issues and test changes.
• Participates in change management procedures to support accurate risk adjustment team documentation and process flows.
• Maintains reporting describing results against internal goals, presenting results and updates to leadership.
• Supports external vendor relationships and evaluate data submissions and reconciliation reports.
• Resolves issues and problems by conferring with both internal and external partners, as necessary.
• Maintains professional contact with other departments as needed; attend interdepartmental meetings.

Knowledge / Skills / Abilities

• Demonstrated knowledge with various types and sources of healthcare information, including claim, provider, and patient-level data.

• Ability to perform complex research and analysis of healthcare claims, enrollment, and other related data, to report on network utilization, cost structure, and/or quality.

• Demonstrated knowledge with the specific risk adjustment models. HHS HCC, CMS HCC and MARA.

• Demonstrated knowledge of HCC coding and diagnosis capture optimization.

• Ability to build, perform, and maintain risk adjustment models and analyses for tracking and reporting at the department, senior leadership, and provider level.

• RAD-V audit experience and medical record review.

• Advanced SQL skills for large healthcare database querying.

• Expert-level Excel capabilities including macros and VBA.

• Data science proficiency in R or Python for statistical analysis preferred.

• Strong analytical and creative problem-solving skills.

• Experience doing root cause analysis and reporting.

• Ability to achieve results independently and with a team.

• Excellent oral and written communication skills.

• Excellent communication skills, with the ability to translate complex data into actionable insights.

Qualifications

Required

• Bachelor's Degree required, strong preference in Health Informatics, Public Health, Statistics, Data Science, Applied Math, or related field.
• 2+ years of experience in risk adjustment analytics within a health plan or healthcare organization.
• Proficiency in SQL and data analysis tools (e.g., SAS, Python, R, Excel).
• Familiarity with ICD-10-CM coding, HCC mappings, and risk score calculations.

Preferred

• Medicare Data experience.

Working Conditions and Physical Demands

Employee must be able to meet the following requirements with or without an accommodation.

• This is a sedentary position in an office setting that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.