Senior Compliance Risk Adjustment Analyst

About Our Client

The organization operates in the health insurance industry, using a full-stack technology platform to deliver a streamlined, member-focused insurance experience. Established in 2012, the organization combines healthcare and technology to improve access, engagement, and support for its members.

About the Opportunity

The Specialist, Risk Adjustment supports the Affordable Care Act (ACA) Risk Adjustment team in achieving operational and regulatory goals tied to requirements from the Centers for Medicare & Medicaid Services (CMS) and Health and Human Services (HHS). This role provides daily operational support for Retrospective and/or Prospective Risk Adjustment Programs, helping maintain efficient processes, meet retrieval and outreach targets, and ensure regulatory compliance.

Responsibilities

• Support daily Risk Adjustment operations, including medical record retrieval and provider outreach.
• Maintain oversight of medical record inventory and track progress against established goals.
• Conduct outreach to internal and external partners to meet medical record retrieval targets.
• Represent the Risk Adjustment team when working with partners and help influence positive outcomes.
• Monitor, track, and report on inventory status and progress.
• Develop a detailed understanding of internal workflows, systems, and operational tools.
• Identify opportunities to improve processes and operational efficiency.
• Assist management with operational analysis and decision-making support.
• Ensure activities comply with applicable laws, regulations, and organizational policies.
• Perform additional duties and projects as assigned.

Requirements

• Bachelor's degree or equivalent work experience.
• Minimum 1 year of experience in chart retrieval or provider outreach.
• Minimum 1 year of experience in healthcare operations.
• Minimum 2 years of experience consistently meeting and accomplishing performance goals.
• Preferred: At least 1 year of experience in risk adjustment.
• Strong organizational and communication skills.
• Ability to manage operational priorities and meet regulatory deadlines.
• Ability to work effectively with internal teams and external healthcare partners.

Pay

• Base pay in New Jersey and New York: $29.86–$39.19 per hour.
• Base pay in other states: $26.87–$35.27 per hour.

Benefits

• Eligible for employee benefits.
• Accrual of 15 vacation days per year.