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Career Opportunities

Lead Medicare Risk Adjustment Analyst

Job Title
Lead Medicare Risk Adjustment Analyst
Job ID
Franklin,  TN 37067
Other Location

Title: Lead Medicare Risk Adjustment Analyst

Our History:
From our start in 2009, Conexess has established itself in 3 markets, employing nearly 150+ individuals nation-wide. Operating in over 15 states, our client base ranges from Fortune 500/1000 companies, to mid-small range companies. For the majority of the mid-small range companies, we are exclusively used due to our outstanding staffing track record

Who We Are:
Conexess is a full-service staffing firm offering contract, contract-to hire, and direct placements. We have a wide range of recruiting capabilities extending from help desk technicians to CIOs. We are also capable of offering project based work.

Job Description:
Conexess is needing a Lead Medicare Risk Adjustment Analyst that possesses expertise in risk adjustment methodologies, technical expertise in healthcare analytics, and experience in financial analysis with focus on Medicare risk adjustment.


  • Analyze data flow and data integrity to identify areas for improvement in risk adjusted revenue. 
  • Complete routine quality assurance checks to ensure data accuracy and completeness and execute corrections as needed. 
  • Calculate financial impact of strategic risk adjustment program projects. Use findings to inform strategic priority setting. 
  • Analyze and reconcile claims and encounter data which will include 837 EDI encounter files for EDPS, RAPS and Edge Server submission files
  • Understand Medicare/Medicaid risk score methodology, including: risk score calculation, financial risk receivable calculations, Risk Adjustment Processing System (RAPS) and Encounter Data Processing System (EDS) processes and key regulator deadlines for data submission, RAPS and EDS Return Files and Error Files, understand eligibility, ICD coding, claims, and provider data. 
  • Create and maintain risk mitigation analyses to meet Regulatory requirements. 


  • Working knowledge of  Medicare Advantage and/or ACA/HIX
  • Experience in Medicare EDS/EDPS and/or EDGE server processing
  • Claims processing and error correction experience/understanding
  • Experience with 5010/837 files
  • Experience with XML
  • Advanced data analysis in SQL
  • Excellent application troubleshooting based on data analysis
  • Strong communication skills, both verbal and written
  • Bachelor’s degree in Business or IT related discipline 
  • Ability to work at a detailed level and maintain / retain a “big picture” outlook of overall system design / functionality
  • Ability to effectively communicate with both business and technical staff, conveying complex ideas verbally and in writing

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