• Senior Business Analyst

    Job Locations US-RI-Smithfield
    Req No.
    NHPRI Department
    755 - Medical Expense Management
    Regular Full-Time
  • Overview

    The Senior Business Analyst position is responsible for coordinating activities for optimizing risk adjustment revenue across Neighborhood Health Plan of Rhode Island’s Medicare and Individual/Small Group Exchange population as prescribed by Center for Medicare and Medicaid Services, Department of Health, Health and Human Services or other State and Federal Regulatory Agencies.  This position functions as the Business Lead on various projects and activities.  This position is the primary contact for obtaining and disseminating information from Center for Medicare and Medicaid Services, Department of Health, Health and Human Services or other State and Federal Regulatory Agencies related to Risk Adjustment Program.


    • Directs and coordinates individual projects to ensure Risk Adjustment optimization activities progresses on schedule and the appropriate milestones are met. Maintains adequate communication regarding project status, risks, issues, and priorities with project sponsors and leadership.
    • Ability to support strategic direction for program operations, goals, metrics, tasks, timeframe and appropriate reporting and timing related to all National HCC Activities.
    • Monitor, interact and summarize Regulatory Requirements. Analyzes updates from Center for Medicare and Medicaid Services, Department of Health, Health and Human Services or other State and Federal Regulatory Agencies on a regular (weekly) basis.
    • Develop and maintain policies and procedures. Recommends best practices to ensure maximum performance and ensures that the developed performance benchmarks are met. Documents performance measurements and process changes.
    • Acts as a liaison with internal partners and external partners to identify opportunities and needs and researches/develops implementation plans for meeting these needs.
    • Recognized expert within the function, the division, and the organization. Facilitates project teams and may provide training to lower level staff to achieve milestones and objectives.
    • Responsible for coordinating activities for RADV and other Audit programs.



    • Bachelor's degree in Business or related fields.
    • 5-8 years of Business Experience managing and leading various projects.
    • Expert collaborative, interpersonal, oral and written communication skills and demonstrated ability to develop accurate and appropriate communications to all levels of management.
    • Strong experience with the MS Office suite.
    • Strong problem-solving skills exhibited by the ability to approach complex, ambiguous business issues with creative ideas and solutions.
    • Expert ability to build cross functional relationships, which includes negotiation and persuasion skills.
    • Exceptional ability to work in high paced environment, handling multiple responsibilities and projects.
    • Flexible, self-motivated, and continuously seeking ways to improve.


    • Knowledge of healthcare industry including familiarity with health policy, health insurance, benefit plans and product features, provider contracting approaches, reimbursement approaches and health management approaches.
    • Prior experience in risk adjustment activities in a Medicare, Affordable Care Act or provider organization including submission of RAPs, and EDPS, EDGE Server files submission, responses and reconciliation per CMS and other State and Federal Guidelines.
    • Knowledge of claims coding and payment methodology, associated with a Health Plan domain.
    • Strong background in CPT, HCPCS, and related Hierarchical Condition Coding (HCC) Methodologies.

    Organizational Competencies:

    • Judgment and Decision Making
    • Gets Results
    • Collaboration and Teamwork
    • Business Awareness
    • Customer Focus


    Job Specific Competencies:

    • Attention to Detail
    • Creativity &  Innovation
    • Relationship Building & Networking
    • Continuous Quality Improvement
    • Planning & Organization

    FDR Oversight:

    • Business Lead Level:

    In the role of business lead for assigned FDR; incumbent is responsible to complete comprehensive oversight and monitoring of their vendor that incorporates the following elements: efficient and effective operations; compliance with laws, regulations, policies, procedures; and other company performance issues designed to reduce risk and add value to the company


    Flexible Work Arrangement:

    • Yes

    Telecommuting Arrangement:

    • Yes (1 day a week after 6 months of employment)

    Travel Expectations:

    • Local Business Travel

    Neighborhood is an Affirmative Action and Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status or any other legally protected basis.


    Neighborhood is committed to ensuring individuals with disabilities and/or those who have special needs participate in the workforce and are afforded equal opportunity to apply for jobs. If you would like to contact us regarding the accessibility of our Website or need assistance completing the application process, please contact us at recruiting@nhpri.org.


    Neighborhood is an EOE M/F/D/V and an E-Verify Employer


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