Adjustment Clerk jobs in Utica, NY

Who We Are

Porter combines the power of analytics with the power of care. Porter is a leading healthcare IT and services platform for care and coverage coordination that optimizes outcomes and member experience. We deliver understanding, compassion, information, and peace of mind for your members. Driven by robust AI analytics, Porter’s Care Guide team helps the member navigate the healthcare delivery system, secures the right support for each member’s specific needs, and directs Porter’s team of expert clinicians to perform comprehensive in-home assessments, complete with lab and diagnostic testing. By coordinating the complexities of each unique care journey, Porter helps close the gaps with the largest impact on quality measures, total cost of care, risk adjustment, and member experience. 

Who You Are

  The ideal member of Porter will be a change agent, altering the status quo of healthcare delivery. You and your fellow Porter team members will provide an innovative and empathetic ecosystem of transparency to our members. New team members will join feeling energetic and excited to revolutionize the healthcare continuum and contribute to the success of our mission driven organization. 

What You'll Do

 As a Risk Adjustment Data Analyst at Porter, you will be responsible for leveraging your expertise in healthcare data analysis to help our payer clients identify and address coding and documentation gaps that impact risk adjustment revenue. You will play a vital role in analyzing complex datasets, developing actionable insights, and collaborating with clients to implement effective risk adjustment strategies. 

Responsibilities: 

- Utilize advanced analytics techniques to analyze payer data and identify opportunities for improving risk adjustment coding accuracy and completeness. 

- Conduct in-depth reviews of medical records, claims data, and other relevant sources to identify and validate Hierarchical Condition - - ---C-- Categories (HCCs) and other risk adjustment factors. 

- Collaborate closely with payer clients to develop and implement data-driven strategies for optimizing risk adjustment revenue and mitigating compliance risks. 

- Develop predictive models and algorithms to identify potential coding and documentation discrepancies and proactively address them before submission. 

- Provide strategic guidance and recommendations to payer clients based on data analysis findings, industry best practices, and regulatory requirements. 

- Support cross-functional teams in the design, implementation, and evaluation of risk adjustment initiatives and programs. 

- Conduct end-of-year project reporting and ROI analysis on the in-home assessments provided by Porter as a service, ensuring that clients have visibility into the impact of these assessments on risk adjustment outcomes and overall performance. 

- Guide and lead quarterly business reviews with Porter customers, providing insights and recommendations based on data analysis findings and collaborating with clients to identify opportunities for improvement and optimization.  

What You'll Need

Qualifications: 

- Bachelor's degree in statistics, data science, healthcare administration, or a related field. Master's degree preferred. 

- At least 5 years of experience in healthcare data analysis, with experience in risk adjustment and payer operations. 

- Proficiency in SQL, SAS, Python, or similar data analysis tools and programming languages. 

- Strong understanding of healthcare coding systems (e.g., ICD-10, CPT, HCPCS) and risk adjustment methodologies (e.g., CMS-MA, HHS-ACA, CDPS-MCD 

- Strong understanding of CMS/HHS data sets, response files, and submission processes.  

- Excellent analytical and problem-solving skills, with the ability to translate complex data into actionable insights. 

- Effective communication and presentation skills, with the ability to convey technical concepts to non-technical stakeholders 

 - Proven track record of driving results and delivering value to payer clients through data-driven solutions. 

- Ability to work collaboratively in a fast-paced, client-focused environment. 

What We Offer

- Medical, dental, and vision benefits within 30 days of hire

- Paid vacation and holidays

- A fun team and special culture