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Business Analyst, Risk Adjustment

3 months ago

Seattle, Washington, United States Community Health Plan of Washington Full time

Business Analyst, Risk Adjustment

Job Category*:

  • Accounting & Finance

Requisition Number*:

  • BUSIN001595
Showing 1 location

Job Details

Description

Job Summary

The Business Analyst, Risk Adjustment has expertise in all aspects of risk adjustment data submissions, ensures encounter submission completeness and accuracy and enables the analytics team to perform complex analyses.


Essential Functions

  • Oversee Risk Adjustment data submission to CMS including EDGE server and RAPS/EDS submissions, work with appropriate stakeholders to assess accuracy, identify opportunities, troubleshoot and resolve data submission issues.
  • Develop and monitor dashboard and other performance reporting.
  • Maintain current knowledge of full scope of encounter data submission and processing requirements and coordinate all activities to ensure complete and accurate data submission.
  • Build and sustain collaborative relationships with internal and external stakeholders to foster an increased understanding of the risk adjustment encounter data submission and audit process.
  • Serves as a primary liaison for data submissions with key departments including Finance, Healthcare Economics, Operations, IS&T, and Eligibility. Lead program meetings with key stakeholders and track deliverables.
  • Track all applicable risk adjustment encounter data submission and RADV deadlines and ensure business teams and vendors are appropriately planning. Handle communications with CMS regarding data submissions and management of risk adjustment data programs. Track required forms.
  • Attend all CMS and vendor trainings related to encounter data submission and RADV management. Ensure stakeholders also attend appropriate sessions based on their topic area.
  • Translate CMS technical requirements related to AWS EDGE Server management, including troubleshooting reporting errors, knowledge of report content, and troubleshooting of error processing with business team.
  • Create and maintain policies, procedures, process flows, workflows, and requirements documents related to EDGE Server and EDS submissions, ensuring alignment with all functional areas supporting encounter data submissions. Utilize CMS encounter data processing guides and vendor documentation to ensure process accuracy.
  • Lead the completion of all RADV deliverables for documentation and validation of member enrollments, collection of charts, white papers and ad-hoc requests to ensure audit submissions.
  • Work closely with risk adjustment team to track accrual estimates and file submission status. Track data submission status, identify and escalate risks related to risk capture.
  • Exempt


Employees are expected to report to work as scheduled, participate in all assigned meetings, and meet established performance and accountability standards.


  • Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.

Qualifications

Education

  • Bachelors degree in Business Administration, Health Information Management, Healthcare Administration, Analytics, or other relevant academic field, or an equivalent combination of education and highly relevant experience required.
Additional Requirements

  • Advanced working knowledge of CMS encounter data and risk adjustment requirements preferred

Experience

  • 2-4 years experience in encounter submission process management, healthcare data, or risk adjustment.
  • Experience in process improvement strongly preferred.
  • Experience with advanced analytic features of SQL, Access and Excel preferred.
Employment Eligibility

  • Complete and successfully pass a criminal background check
  • Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency
Knowledge, Skills, and Abilities

  • Knowledge of risk adjustment requirements and their impact on the organization.
  • Strong analytical skills and the ability to interpret, evaluate and formulate action plans based upon data.
  • Superior organizational, time management, and project management skills.
  • Exceptional facilitation and organizational skills.
  • Effective verbal and written communication skills
  • Collaborate with others in a respectful manner
  • Affinity for analyzing both data and business processes
  • Close attention to detail and accuracy and a drive for excellence.
  • Demonstrated proficiency and experience with Microsoft Office products.
  • Customer focused, self-managing problem solver, accountable and able to thrive in autonomous environments



SENSORY/PHYSICAL/MENTAL REQUIREMENTS

Sensory:

  • Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.

Physical:

  • Extended periods of sitting, computer use, talking and possibly standing
  • Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion
  • Frequent torso/back static position; occasional stooping, bending and twisting
  • Some kneeling, pushing, pulling, lifting and carrying (not over 25 pounds), twisting and reaching

Mental:

  • Must have the ability to learn and prioritize multiple tasks within the scope and guidelines of the position and its applicable licensure requirements, many requiring extremely complex cognitive capabilities. Must be able to manage conflict, communicate effectively and meet time-sensitive deadlines.

WORK ENVIRONMENT
Office environment with frequent environmental exposure to low-grade radiation from computer monitors; fast paced with frequent interruptions.

PROTECTED HEALTH INFORMATION (PHI) ACCESS
All information (written, verbal, electronic, etc.) that an employee encounters while working at CHPW is considered confidential. CHPW employees may encounter protected health information in the regular course of their work at and for CHPW.

This position may be exposed to and required to deal with highly confidential and sensitive material and must adhere to CHPW policies, guidelines, and all applicable laws and regulations at all times.

**Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.
*This job description is intended to describe the general content and the requirements for satisfactory performance in this position. It is not to be construed as an exhaustive statement of the duties, responsibilities or requirements of this position.

Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.

Qualifications

Skills

Behaviors

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Motivations

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Education

Experience

Licenses & Certifications
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant.

However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractors legal duty to furnish information.

41 CFR c)

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