Risk Adjustment Business Analyst (NO C2C)

Why work at OpTech? OpTech is a woman-owned company that values your ideas, encourages your growth, and always has your back. When you work at OpTech, not only do you get health and dental benefits on the first day of employment, but you also have training opportunities, flexible/remote work options, growth opportunities, 401K and competitive pay. Apply today! To view our complete list of openings, please visit our website at www.optechus.com. Job Title: Risk Adjustment Business Analyst Engagement Overview: Our client is seeking an experienced Risk Adjustment Business Analyst to support the successful execution of risk-bearing programs including Medicare Advantage. This role is critical in ensuring compliance with CMS guidelines, reducing audit risk and optimizing population health representation and financial outcomes. The ideal candidate will possess strong analytical skills, a deep understanding of risk adjustment models (e.g., CMS-HCC, V28), and the ability to translate complex regulatory requirements into actionable business and technical processes. This role will collaborate cross-functionally to support vendor oversight, internal audits, quality initiatives, and the coordination of clinical coding projects. Key Responsibilities: • Business Requirements Gathering – Ability to interpret complex regulations and translate them into functional requirements for system/process enhancements. • Reporting & Analytics – Proficiency in analyzing data and generating insights to support decision-making, compliance tracking, and coding accuracy. • Process Improvement – Experience evaluating workflows, managing quality audits, and implementing strategies to optimize risk adjustment processes. • Interpret CMS risk adjustment models and regulatory requirements - In order to inform program strategy. • Gather and document business requirements - Translating them into clear specifications for technical and operational teams. • Develop and maintain reporting dashboards- To track risk adjustment KPIs, coding outcomes, and compliance metrics. • Use data analytics- To identify documentation or coding gaps and support corrective action planning. • Oversee internal and third-party coding projects- Evaluate outcomes and package results for submission. • Lead or contribute to process improvement initiatives- To enhance accuracy, efficiency and regulatory compliance. • Support audit readiness- By managing documentation, process controls and retrospective reviews. • Collaborate with stakeholders across clinical, technical, and operational teams- To drive alignment and program success. Required Skills: • Proficiency in Tableau with the ability to design and maintain insightful dashboards. • Advanced Microsoft Excel skills, including combining workbooks and managing complex datasets. • Knowledgeable in medical coding • Demonstrated expertise in developing reports to support business decision-making and compliance needs. • Strong background in audit preparation and execution, ensuring accuracy and adherence to standards. • Proven problem-solving and critical thinking skills with the ability to address complex challenges. • Exceptional written and verbal communication skills for effective collaboration across teams. • Highly detail-oriented with a consistent focus on accuracy and quality. • Skilled in managing multiple projects simultaneously while meeting deadlines in fast-paced environments. • Experienced in working cross-functionally with clinical, IT, compliance, and leadership stakeholders. • Flexible and adaptable to evolving regulatory requirements and organizational priorities. Education & Certifications: • Bachelor’s degree in Healthcare Administration, Business, Data Science, or a related field with strong analytical coursework. • CPC or RHIT Certifications required OpTech is an equal opportunity employer and is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, status as a parent, disability, age, veteran status, or other characteristics as defined by federal, state or local laws. https://www.optechus.com/eeo_self_identification/