Job Title:Medicare Risk Adjustment Business Analyst (Healthcare payer experience) -Onsite-1 day per week- Grand Rapids, MI Are you a Medicare Risk Adjustment Business Analyst seeking a dynamic and rewarding opportunity? Our client, a leading company in Healthcare, is looking for a talented Business Analyst to join their growing team in Detroit, MI. About Kyyba:Founded in 1998 and headquartered in Farmington Hills, MI, Kyyba has a global presence delivering high-quality resources and top-notch recruiting services, enabling businesses to effectively respond to organizational changes and technological advances. At Kyyba, the overall well-being of our employees and their families is important to us. We are proud of our work culture which embodies our core values; incorporating value, passion, excellence, empowerment, and happiness, creates a vibrant and productive atmosphere. We empower our employees with the resources, incentives, and flexibility that they need to support a healthy, balanced, and fulfilling career by providing many valuable benefits and a balanced compensation structure combined with career development.Kyyba is recruiting for the below mentioned position with our direct client which is one of the major Healthcare Payers in the US. Job Description Will this position be required to work onsite for any reason at any time? Yes, Resource will be required to come onsite– 1 time a week (Grand Rapids Office) 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 operational risk, and contribute to the overall success of Risk Adjustment activities by the plan. The ideal candidate will bring a strong foundation in risk adjustment), reviewing and translating regulatory requirements and helping the business area implement compliant and optimal solutions. Additionally, the Business Analyst will support industry level research to ensure that best practices are implemented that minimize risk, while maximizing health outcomes for the organization's members. 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: o They research, interpret and understand CMS regulations and applicable laws pertaining to risk adjustment o They collaborate with stakeholders to gather and document business requirements for risk adjustment programs, translating them into functional specifications for business teams. • Risk Management o They develop and implement risk assessment and monitoring review processes to mitigate and/or remediate risk within the risk adjustment space o They track and manage corrective action plans to address identified compliance risks and deficiencies • Process Improvement: o They analyze existing controls and processes against guidance to enhance and strengthen those processes and controls in alignment with current guidance and best practices. o They support the documentation, implementation and tracking of controls and systems which create enhanced efficiency and effectiveness. Required Skills/Experience – The rest of the required skills/experience. Include: • Technical Skills: o Data Analysis: Ability to analyze large datasets to identify trends, patterns, and anomalies related to risk adjustment and compliance. This includes:  Using data analysis tools and software.  Interpreting data to understand risk adjustment and compliance issues. o Business Intelligence (BI) and Reporting: Experience with BI tools and reporting platforms to create dashboards and reports for monitoring risk adjustment performance and compliance. o Proficiency in MS Office applications • Business Skills: o Risk Adjustment Program Knowledge: Understanding of relevant risk adjustment programs, such as Medicare Advantage, and their specific compliance requirements. o Regulatory Compliance: Knowledge of healthcare regulations and laws, including HIPAA, and how they apply to risk adjustment data and processes. o Business Process Analysis: Ability to analyze existing business processes, identify inefficiencies, and recommend improvements to enhance compliance and performance. o Problem-solving: Ability to identify and assist with resolving complex compliance issues related to risk adjustment data and processes. o Communication: Excellent verbal and written communication skills to effectively communicate with internal teams, external partners, and regulatory bodies. o Attention to Detail: Meticulous attention to detail to ensure accuracy and compliance in data and processes. o Research: Ability to review conduct research and review of regulatory guidance to interpret and implement. o Project Management: Ability to manage projects related to risk adjustment initiatives and compliance projects, requiring skills like defining scope, identifying resources, and scheduling. o Stakeholder Management: Ability to collaborate effectively with various stakeholders, including clinical staff, IT teams, and management. o Critical Thinking and Decision-Making: Ability to analyze situations, make informed decisions, and develop solutions to complex problems. o Adaptability: Ability to adapt to changes in regulations and risk adjustment programs. Preferred Skills/Experience – Optional but preferred skills/experience. Include: • Prior roles in a compliance and/or regulatory department Education/Certifications – Include: • Bachelor's degree in healthcare administration, business, or a related field with strong quantitative and analytical coursework • Compliance related certification, e.g., CHC, CCP would be a plus, not required Education/Certifications – Include: • Bachelor's degree in healthcare administration, business, data science, or a related field with strong quantitative and analytical coursework Disclaimer: Kyyba is an Equal Opportunity Employer. Kyyba does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other basis covered by appropriate law. Minorities / Females / Protected Veterans / Individuals with Disabilities are encouraged to apply. All employment is decided on the basis of qualifications, merit, and business need.” It is the policy of Kyyba to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact Kyyba at 248-813-9665 Rewards: Medical, dental, vision 401k Term life Voluntary life and disability insurance Optional Pre-paid legal plan Optional Identity theft plan Optional Medical and dependent FSA Work-visa sponsorship Opportunity for advancement Long-term assignment with opportunity for hire by client SELECT AWARDS • An INC 5000 company for 10 years • Corp! 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