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Department

*Must Be A Colorado Resident

Job Summary

The Risk Adjustment Analyst will support DHMP's Medicare Advantage and ACA Marketplace lines of business. This position plays a key role in supporting risk adjustment strategy, resolving EDGE submission issues, coordinating with vendors, and ensuring data quality and regulatory compliance.

Essential Functions:

• Develop and maintain complex SQL queries, stored procedures, and data models to extract and analyze claims, encounter, and clinical data for Medicare Advantage and ACA Marketplace populations (20%)
• Create advanced data mining algorithms and targeting models to identify risk adjustment opportunities, coding gaps, and high-impact member-level interventions (20%)
• Investigate and help resolve EDGE server rejections to ensure completeness and accuracy of data submissions performed by external vendors (20%)
• Prepare quarterly and annual reports for senior leadership, including risk adjustment performance, operational metrics, and regulatory insights (20%)
• Apply deep knowledge of ACA and CMS-HCC/CMS-RxHCC risk adjustment methodologies, including coefficient updates and risk score calculations (15%)
• Develop and maintain executive dashboards and reports that track KPIs such as risk score trends, provider performance, coding velocity, and financial outcomes (5%)

Education:

• Bachelor's Degree Economics, Statistics, Actuarial Science, Public Health, Mathematics, or a related quantitative field required

Work Experience:

• 3-5 years of health insurance or healthcare analytics experience across Medicare Advantage and ACA products required and
• 2+ years of direct, hands-on experience with ACA and Medicare Advantage risk adjustment programs required

Licenses:
Knowledge, Skills and Abilities:

• Strong data analysis skills and advanced SQL proficiency
• Experience researching and resolving EDGE submission rejections
• Strong written and verbal communication skills

Shift

Work Type

Salary

Benefits

• Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans

• Free RTD EcoPass (public transportation)

• On-site employee fitness center and wellness classes

• Childcare discount programs & exclusive perks on large brands, travel, and more

• Tuition reimbursement & assistance

• Education & development opportunities including career pathways and coaching

• Professional clinical advancement program & shared governance

• Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program 

• National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

Our Values

• Respect

• Belonging

• Accountability

• Transparency

All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.

Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver’s 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation.

As Colorado’s primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year.

Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.

Denver Health is an equal opportunity employer (EOE). We value the unique ideas, talents and contributions reflective of the needs of our community.

Applicants will be considered until the position is filled.

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About Denver Health

Take your career to the next level at Denver Health, where we offer a robust benefits package and endless opportunities for growth. Denver Health is a nationally-ranked, locally-trusted, premier healthcare institution located in the heart of Denver, Colorado.Twenty-five percent of all Denver residents, or approximately 150,000 individuals, receive their health care here. We are known as an integrated health care system that encompasses multidisciplinary academic specialties, a community health system, a level I adult trauma center, pediatric emergency and urgent care center home to Denver Public Health and many of the nation's leaders in medicine.Denver Health is an Equal Opportunity Employer At Denver Health we pride ourselves on our commitment to diversity. Equal opportunity is a fundamental principle of Denver Health. As an equal opportunity employer, Denver Health is committed to recruit, hire, promote and administer all human resource actions in a non-discriminatory manner. Denver Health is committed to providing equal opportunities in all business practices and to all persons regardless of age, race, color, national origin, genetic information, religion, sex, pregnancy, disab...ility, sexual orientation, gender identity, gender expression, marital status or veteran status (collectively “protected status”). Denver Health strives to maintain a work environment that is free from unlawful harassment and discrimination and will not tolerate any such conduct by employees or directed at employees within the scope of their employment. Read the full Human Resources Employee Principles and Practices policy.

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