Business Analyst

Location: Fully Remote (US)

Timezone Requirement: Must reside in Eastern Standard Time (EST) or Central Standard Time (CST)

Position Overview

Are you a healthcare data enthusiast who thrives at the intersection of operational compliance, financial analytics, and clinical workflows? We are seeking a high-caliber Business Analyst to join our dynamic team supporting the Coding and Comprehensive Health Assessment Programs (CHAPs) departments. You will serve as the strategic analytical engine driving compliance, data integrity, and operational efficiencies across our Medicare Advantage and Risk Adjustment workflows.

In this position, you will directly manipulate large-scale healthcare data sets to identify trends, mitigate compliance risks with CMS regulations, optimize coder workflows, and uncover opportunities that directly impact clinical operations and accurate market reimbursement models.

Essential Functions & Key Responsibilities

• Data Analytics & Interpretation: Complete routine and complex data analysis projects, process mapping, and workflow modeling. Identify variances, performance trends, and anomalies within Risk Adjustment and clinical documentation datasets.
• Operational Solutions: Conduct end-to-end business process assessments across coding operations and CHAPs workflows. Formulate data-driven strategies, tactics, and solutions to eliminate process bottlenecks.
• Reporting & Metric Architecture: Prepare, maintain, and expand a dynamic library of key performance measures, dashboards, and automated operational reports. Manage recurring scheduled reports while balancing concurrent ad hoc project requests.
• Cross-Functional Partnership: Act as an embedded analytical partner to Department Heads, Clinical Leaders, and Matrixed Operations teams to drive strategic market initiatives to completion.
• Data Governance & Compliance: Ensure absolute data integrity and regulatory alignment with CMS guidelines. Protect and disclose patients’ protected health information (PHI) in strict compliance with HIPAA standards.

Required Experience & Qualifications

• Education: Bachelor’s degree in Healthcare Administration, Business Administration, Finance, Health Informatics, or a closely related field (or equivalent specialized work experience).
• Domain Expertise: Minimum of 2+ years of hands-on data analytics experience within the healthcare field.
• Industry Knowledge: Strong operational familiarity with Medicare Advantage, Managed Care, Capitation models, and medical group structures (clinical operations, care management).
• Mindset: A self-starter with an elite sense of personal accountability and a passion for owning projects in a fast-paced, high-energy environment.

Advanced Technical Skills Required

To be successful in this role, you must be a technical power user capable of transforming raw healthcare records into structured operational insights.

• Excel Power User: Expert-level spreadsheet management and financial/operational modeling. Must easily manipulate large volumes of data, build advanced pivot tables, and use complex formulas (INDEX/MATCH, XLOOKUP, nested IF statements, etc.). Experience writing advanced macros is highly preferred.
• Database & Querying: Expert proficiency in SQL or MS Access to query, filter, and extract data from data warehouses or Electronic Health Records (EHR).
• Process Mapping: Hands-on experience utilizing Microsoft Visio to map out complex, multi-layered workflows, swimlane diagrams, and operational bottlenecks.

Preferred Skills & Core Target Keywords

Candidates who highlight experience in the following specific sub-domains will be prioritized:

• Hierarchical Condition Categories (HCC) & Risk Adjustment Factor (RAF) scoring models.
• Familiarity with RAPS (Risk Adjustment Processing System) or EDPS (Encounter Data Processing System) CMS data submissions.
• Experience metrics-tracking chart auditing workflows or coder productivity/error rates.
• Familiarity with data visualization platforms (Power BI or Tableau).

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All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.

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