Business Analyst Risk Adjustment (Healthcare Payor Domain)

Job Summary:

We seek an experienced Business Analyst with a strong background in Risk Adjustment within the Healthcare Payor domain. This role is ideal for a professional who can bridge the gap between business needs and technical solutions, specifically in projects related to risk adjustment, regulatory compliance, and Medicare/Medicaid programs. The position will support strategic initiatives for our client, Elevance Health, and requires deep industry knowledge and strong analytical and communication skills.

Key Responsibilities:

• Act as a liaison between business stakeholders and technical teams to gather, analyze, and document requirements related to Risk Adjustment programs.
• Support the development, implementation, and optimization of risk adjustment models (Medicare Advantage, ACA, Medicaid).
• Collaborate with cross-functional teams to ensure alignment of project goals with regulatory and compliance standards.
• Translate business needs into functional requirements, process flows, user stories, and acceptance criteria.
• Conduct data analysis to support gap identification and improvement opportunities in risk adjustment data submissions and processes.
• Facilitate requirement review sessions and provide subject matter expertise on risk adjustment methodologies, CMS/HHS regulations, and industry best practices.
• Assist in testing efforts (UAT, SIT) to ensure delivered solutions meet business expectations.
• Provide ongoing support and recommendations for enhancements to risk adjustment platforms and workflows.

Required Qualifications:

• 5+ years of experience as a Business Analyst in the Healthcare Payor domain, with significant experience in Risk Adjustment.
• Deep understanding of Medicare Advantage, Medicaid, ACA, and risk adjustment regulations.
• Experience working with HCC coding, encounter data, and risk score analytics.
• Strong knowledge of CMS and HHS Risk Adjustment models.
• Ability to work effectively in a remote, cross-functional team environment.
• Proven experience in writing BRDs, FRDs, user stories, and conducting stakeholder workshops.
• Excellent verbal and written communication skills.

Preferred Qualifications:

• Experience working with or for Elevance Health or similar major health insurance organizations.
• Familiarity with tools such as JIRA, Confluence, SQL, Tableau, or similar.
• Certified Business Analyst Professional (CBAP) or similar certification is a plus.

To Apply: Please submit your resume along with a brief summary of your relevant experience with Risk Adjustment projects in the healthcare payor space.