Risk Adjustment Analyst II

2 weeks ago

Seattle, United States Community Health Plan of Washington Full time
Job DescriptionJob Description

Who we are

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.

Our commitment is to:

  • Strive to apply an equity lens to all our work.
  • Reduce health disparities.
  • Become an anti-racist organization.
  • Create an equitable work environment.

About the Role

Support CHPW’s risk adjustment activities, advancing the effectiveness and value of population health and risk adjustment initiatives through targeted analytics. This role is integral in driving improved health outcomes and reducing overall healthcare costs.

To be successful in this role, you:

  • Bachelor’s degree in quantitative discipline such as Mathematics, Statistics, Actuarial Science or Economics, or related field, or an equivalent combination of education and highly relevant experience
  • Have a minimum of three (3) years’ experience analyzing healthcare claims/encounter data
  • Have Experience in Commercial, Medicare and/or Medicaid Risk Adjustment models
  • Proven analytical and quantitative skills, including experience with managing and modeling of large data sets
  • Have applied understanding of risk adjustment model(s)

Essential functions and Roles and Responsibilities:

  • Design, develop, and implement in depth analyses, reporting, dashboards, and trend analysis to support internal and external business customers.
  • Supports or leads projects/initiatives that span departments and hold accountability for providing analytic support.
  • Conducts routine and complex quantitative analyses and data validation using tools such as SQL, SAS, Excel, Tableau or other analytical software.
  • Works with stakeholders and team to understand business questions and problems and to scope data analysis and reporting requests.
  • Manages the analytic component of complex departmental projects, including audits.
  • Maintains compliance with CMS requirements, modeling financial impacts to changes in risk adjustment data and methodologies.
  • Effectively tracks and monitors performance of retrospective and prospective risk adjustment programs, identifying issues and making recommendations.
  • Supports encounter data reporting processes for EDPS, RAPS and the EDGE server, including tracking, reporting, and resolving rejections. Conducts gap analysis and data validation, identifying possible issues in data submission and determining financial impact.
  • Works directly with IS&T, Operations, and external vendors to ensure submission of accurate and complete risk adjustment data.
  • Provides decision support for department, including data requests for financial statement accruals, bids, and budget.
  • Analyze, reconcile, and evaluate/interpret complex data from various sources, maintaining data consistency and integrity. Proposes and implements innovative approaches to creating or improving automation, optimizing department processes where appropriate.
  • Maintain ongoing quality control of delivered reports through self-review and peer review, ensuring reports have a high degree of credibility with all users.
  • Complete ad hoc analyses to support internal and external customers.
  • Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.

Knowledge, Skills, and Abilities:

  • Ability to analyze, organize, and prioritize work while meeting multiple deadlines.
  • Skilled at collecting and analyzing complex data.
  • Skilled in using logic and reasoning to identify strategies and weaknesses or alternative solutions, conclusions, or approaches to problems.
  • Knowledgeable of data management methods.
  • Highly skilled in using Microsoft Office, such as Outlook, Teams, Word, and Outlook.

As part of our hiring process, the following criteria must be met:

  • Complete and successfully pass a criminal background check.

Criminal History: includes review of criminal convictions and probation. CHPW does not automatically or categorically exclude persons with a criminal background from employment. The applicant’s criminal history will be reviewed on a case-by-case basis considering the risk to the business, members, and/employees.

  • 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.
  • Vaccination requirement (CHPW offers a process for medical or religious exemptions)
  • 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.

Compensation and Benefits:

The position is FLSA Exempt and is not eligible for overtime. Based on market data, this position grade is 68E (see full range below) and has a 10% annual incentive target based on company, department, and individual performance goals.

CHPW offers the following benefits for Full and Part-time employees and their dependents:

  • Medical, Prescription, Dental, and Vision
  • Telehealth app
  • Flexible Spending Accounts, Health Savings Accounts
  • Basic Life AD&D, Short and Long-Term Disability
  • Voluntary Life, Critical Care, and Long-Term Care Insurance
  • 401(k) Retirement and generous employer match
  • Employee Assistance Program and Mental Fitness app
  • Financial Coaching, Identity Theft Protection
  • Time off including PTO accrual starting at 17 days per year.
  • 40 hours Community Service volunteer time
  • 10 standard holidays, 2 floating holidays
  • Compassion time off, jury duty

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 be able to manage conflict, communicate effectively and meet time-sensitive deadlines.

Work Environment:

Office environment Employees who frequently work in front of computer monitors are at risk for environmental exposure to low-grade radiation.

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