Data Analyst

About The Company

Community First Health Plans is a leading healthcare organization dedicated to providing comprehensive and quality health insurance solutions to diverse communities. With a focus on member-centered care, innovative health management strategies, and a commitment to improving health outcomes, the company strives to deliver value-driven services that meet the evolving needs of its members. Community First Health Plans partners with a broad network of healthcare providers, leveraging advanced technology and data analytics to optimize care delivery and ensure regulatory compliance. The organization fosters an inclusive and collaborative work environment, encouraging professional growth and excellence in healthcare services.

About The Role

The Risk Adjustment Data Analyst plays a vital role within Community First Health Plans by supporting the organization’s risk adjustment initiatives through comprehensive data analysis, reporting, and medical record retrieval. This position involves coordinating with internal departments, provider networks, and external vendors to ensure the accurate collection and interpretation of risk adjustment data. The analyst utilizes health informatics tools and analytics platforms to identify trends, monitor key performance indicators, and support Hierarchical Condition Category (HCC) capture efforts to enhance risk adjustment outcomes. Additionally, the role involves assisting with medical record retrieval, data validation, provider performance analysis, and regulatory reporting to ensure compliance with CMS requirements and organizational objectives.

Qualifications

• Bachelor’s degree in Healthcare Administration, Health Informatics, Data Analytics, or a related field (preferred)
• Minimum of two (2) years of experience in healthcare data analysis and medical record retrieval
• Experience in Risk Adjustment, managed care, health plan operations, or healthcare analytics (preferred)
• Knowledge of healthcare data, electronic health records (EHRs), and medical record retrieval processes
• Proficiency in Microsoft Excel and data analytics tools such as Power BI or similar platforms
• Strong analytical, organizational, and communication skills
• Ability to collaborate effectively with providers, vendors, and cross-functional teams

Responsibilities

• Support the organization’s Risk Adjustment program through detailed data analysis and reporting
• Coordinate medical record retrieval initiatives to ensure timely and accurate data collection
• Utilize health informatics tools to identify trends and monitor key performance indicators related to risk adjustment
• Assist in capturing Hierarchical Condition Categories (HCC) to optimize risk scores
• Validate data accuracy and perform quality checks to ensure compliance with CMS and organizational standards
• Analyze provider performance and identify opportunities for improvement
• Prepare and submit regulatory reports related to risk adjustment activities
• Collaborate with internal teams, external vendors, and provider networks to facilitate seamless data exchange and communication
• Support continuous process improvements in data collection, analysis, and reporting workflows

Benefits

• Competitive salary package
• Health, dental, and vision insurance plans
• Retirement savings plan with employer contributions
• Paid time off and holidays
• Professional development and training opportunities
• Work-life balance initiatives and a collaborative work environment
• Opportunities for career advancement within a growing organization

Equal Opportunity

Community First Health Plans is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, or veteran status.