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Risk Adjustment Analyst

2 months ago

Topeka, United States Kansas Action for Children Full time

at Blue Cross Blue Shield of Kansas in Topeka, Kansas, United States Job Description

Blue Cross and Blue Shield of Kansas has an opportunity for a Risk Adjustment Analyst to join our team. This position is responsible for reporting accurate and timely Medicare Advantage (MA) risk adjustment data to leadership and Centers for Medicare & Medicaid Services (CMS), executing and monitoring risk adjustment and MA Stars improvement initiatives in coordination with multiple corporate divisions and vendors, and developing estimates of risk adjustment payments. “This position is eligible to work hybrid (9 or more days a month onsite) in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.” Why Join Us? Professional Growth Opportunities:

Advance your career with ongoing training and development programs both through our internal Blue University and external opportunities. Make a Positive Impact:

Your work will directly contribute to the health and well-being of Kansans. Stability:

80 years of commitment, compassion, and community Inclusive Work Environment:

We pride ourselves on fostering a diverse and inclusive workplace where everyone is valued and respected. Balance:

paid vacation and sick leave with paid maternity and paternity available immediately upon hire What you’ll do Develop and maintain subject matter expert knowledge of the CMS ACA/MA risk adjustment program requirements and methodologies. Review CMS communications pertaining to ACA/MA risk adjustment. Propose policy and procedure changes to comply with any new CMS requirements. Facilitate accurate and timely ACA/MA risk adjustment reporting to CMS, to maintain compliance with internal and federal requirements and optimize revenue. Maintain reporting and modeling tools to achieve that end and identify and develop tool improvements. Analyzes and researches RAPS/EDPS files, RAPS return files, and EDPS return files to reconcile RAPS/EDPS submissions against CMS technical specifications. Collaborates with external vendors and internal staff to resolve any errors. Help with data analysis for the annual audits. Analyzes HEDIS data, including data audits, roadmap (data flow process) documentation, reports, statistical analysis, medical record extraction, and other HEDIS-related activities as needed. Assist with the development of provider education materials related to ACA/MA risk adjustment. Participate in the ACA/MA Risk Adjustment Data Validation (RADV) audit process, as they arise, working with external parties and internal staff to meet CMS requirements. Analyze risk performance for trend identification and to inform strategy development. Assist with the development of ACA/MA risk adjustment improvement initiatives & incentive programs.

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