Title: Business Analyst Sr Work Location: Lansing, MI, 48901 Duration: 8+ Months Job Type: Contract Work Type: Hybrid Dept: SHS Risk Management Payrate:$ 45.00 - 45.00/hr. Overview: TekWissen is a global workforce management provider headquartered in Ann Arbor, Michigan that offers strategic talent solutions to our clients world-wide. Our client is a health insurance company. It offers different types of health care coverage plans that include individual and family, dental and vision, plans for employers, etc. Engagement Description: • This engagement requires a highly skilled Risk Adjustment Business Analyst who can bridge regulatory requirements with operational execution across Medicare Advantage and other risk-bearing programs. • The analyst will help ensure compliance with CMS guidelines, minimize audit risk, and contribute to accurate population health representation and financial performance. • The ideal candidate will bring a strong foundation in interpreting complex risk adjustment models (e.g., CMS-HCC, V28), gathering and translating business requirements, and using data analytics to identify gaps and opportunities. • In addition to supporting vendor oversight, quality improvement efforts, and internal audit preparedness, the analyst will coordinate coding projects internally and with third-party coding platforms, evaluate the results, and package those outcomes for submission. • Success in this role demands cross-functional collaboration, critical thinking, and the ability to operate in a fast-paced, high-stakes environment. • This engagement directly supports our organization’s ability to remain compliant, optimize RAF accuracy, and achieve sustainable reimbursement outcomes. Top 3 Required Skills/Experience: Business Requirements Gathering: • They interpret complex risk adjustment programs, initiatives, data, and relevant regulations. • They collaborate with stakeholders to gather and document business requirements for risk adjustment programs, translating them into functional specifications for technical teams. Reporting and Analytics: • They develop and maintain reports to track key performance indicators (KPIs) related to risk adjustment coding and provide insights for decision-making. • They utilize data analytics to identify potential data issues and proactively address them and assists with plans to implement effective compliance controls. Process Improvement: • They analyze existing processes, identify areas for improvement, and develop strategies to enhance operational efficiency and accuracy in risk adjustment processes. • They manage quality audits and reviews of clinical documentation and coding practices to support accurate risk adjustment. • They assist with implementing and monitoring compliance controls, ensuring adherence to regulations and reducing the risk of non-compliance. Required Skills/Experience – The rest of the required skills/experience. Include: Business Skills: • Risk Adjustment Program Knowledge: Understanding of relevant risk adjustment programs, such as Medicare Advantage, and their specific compliance requirements. • Business Process Analysis: Ability to analyze existing business processes, identify inefficiencies, and recommend improvements to enhance compliance and performance. • Requirements Gathering and Documentation: Experience in gathering requirements from stakeholders, documenting business processes, and creating functional specifications for system enhancements. • Problem-solving: Ability to identify and assist with resolving complex compliance issues related to risk adjustment data and processes. • Communication: Excellent verbal and written communication skills to effectively communicate with internal teams, external partners, and regulatory bodies. • Attention to Detail: Meticulous attention to detail to ensure accuracy and compliance in data and processes. • Project Management: Ability to manage projects related to risk adjustment initiatives and compliance projects, requiring skills like defining scope, identifying resources, and scheduling. • Stakeholder Management: Ability to collaborate effectively with various stakeholders, including clinical staff, IT teams, and management. • Critical Thinking and Decision-Making: Ability to analyze situations, make informed decisions, and develop solutions to complex problems. • Adaptability: Ability to adapt to changes in regulations and risk adjustment programs Preferred Skills/Experience – Optional but preferred skills/experience. Include: • SQL Databricks experience • Other relevant certifications: Depending on the specific role and focus, other certifications like the Certified Professional in Healthcare Information & Management Systems (CPHIMS), Certified Professional Medical Auditor (CPMA), or certifications related to specific risk adjustment models (e.g., Medicare Advantage) may also be preferred or beneficial. • CRC certified Education/Certifications – Include: • Bachelor's degree in healthcare administration, business, data science, or a related field with strong quantitative and analytical coursework TekWissen® Group is an equal opportunity employer supporting workforce diversity.