Risk Adjustment Analyst

**Risk Adjustment Analyst Advanced**

Requisition ID: Risk Analyst 2

Department: 500618 Risk Adjustment

Facility: Hometown Health Management

Schedule: Full Time

Shift: Day

Category: Professional

Location: Reno,NV

Position Overview Benefits This position develops and coordinates the risk adjustment improvement and reporting efforts, for Hometown Healths Medicare and Commercial products utilizing a variety of source systems and development tools. Included within the scope of this position, the analyst will perform data extraction, analysis, report design, report build, solution deployment, and draft documentation to support the Financial and Business reporting solutions for Hometown Health. Accurate and timely project status feedback is expected to ensure compliance with established timelines.

**KNOWLEDGE, SKILLS & ABILITIES:**

1. Perform analysis and reporting activities relating to: risk score calculation, claims/encounters data submission, chart review programs, audits, and related performance metrics.

2. Participate in the development of requirements, testing and refinement of the underlying data and systems.

3. Collaborate with other business units to deliver reports/updates on underlying data and systems as used by the Risk Adjustment team.

4. Analyze data flow and data integrity to identify areas for improvement.

5. Understand and advise on CMS risk score methodology, including risk score calculation, hierarchical condition categories (HCCs), financial risk receivable calculations, RAPS and EDS processes and key regulator deadlines for data submission, RAPS and EDS Return Files and Error Files, ICD coding, claims, and provider data.

6. Operate risk adjustment analytic vendor platforms to assist with intervention tracking, monitoring, analysis and reporting of diagnosis codes that drive risk score calculations.

7. Work cross functionally across multiple departments to design and develop financial dashboards, KPIs, and models to identify and track profit/loss and ROI trends.

8. Collaborate with Risk Adjustment Coders and Risk Adjustment Nurses to build internal projects based on diagnosis code, procedures, etc. trends for prospective and/or retrospective review.

9. Contribute to developing materials and presenting key updates to Senior Leadership regarding risk adjustment programs and provider and member engagement initiatives.

**Minimum Qualifications**

Requirements Required and/or Preferred Education:

Bachelors degree from an accredited institution required.

Preferred concentration in Business, Finance, Economics, Computer Science or Management Information Systems.

Experience:

1. Minimum of two years in an analyst role required, preferably in the healthcare industry.

2. Advanced Excel skills required, that include working with large data sets, creating standardized reports, utilizing vLookups and advanced functions/ formulas; creating, using and interpreting pivot tables, filtering and formatting.

3. Preferred work experience with SAS and/or SQL to create queries, pull large data sets and perform data manipulations/analysis

4. Preferred experience with ICD codes, medical claims, Medicare Advantage and Commercial/ACA products.

Benefits **Location:** Reno , NV This position develops and coordinates the risk adjustment improvement and reporting efforts, for Hometown Healths Medicare and Commercial products utilizing a variety of source systems and development tools. Included within the scope of this position, the analyst will perform data extraction, analysis, report design, report build, solution deployment, and draft documentation to support the Financial and Business reporting solutions for Hometown Health. Accurate and timely project status feedback is expected to ensure compliance with established timelines.

**KNOWLEDGE, SKILLS & ABILITIES:**

1. Perform analysis and reporting activities relating to: risk score calculation, claims/encounters data submission, chart review programs, audits, and related performance metrics.

2. Participate in the development of requirements, testing and refinement of the underlying data and systems.

3. Collaborate with other business units to deliver reports/updates on underlying data and systems as used by the Risk Adjustment team.

4. Analyze data flow and data integrity to identify areas for improvement.

5. Understand and advise on CMS risk score methodology, including risk score calculation, hierarchical condition categories (HCCs), financial risk receivable calculations, RAPS and EDS processes and key regulator deadlines for data submission, RAPS and EDS Return Files and Error Files, ICD coding, claims, and provider data.

6. Operate risk adjustment analytic vendor platforms to assist with intervention tracking, monitoring, analysis and reporting of diagnosis codes that drive risk score calculations.

7. Work cross functionally across multiple departments to design and develop financial dashboards, KPIs, and models to identify and track profit/loss and ROI trends.

8. Collaborate with Risk Adjustment Coders and Risk Adjustment Nurses to build internal projects based on diagnosis code, procedures, etc. trends for prospective and/or retrospective review.

9. Contribute to developing materials and presenting key updates to Senior Leadership regarding risk adjustment programs and provider and member engagement initiatives.

**Minimum Qualifications**

Requirements Required and/or Preferred Education:

Bachelors degree from an accredited institution required.

Preferred concentration in Business, Finance, Economics, Computer Science or Management Information Systems.

Experience:

1. Minimum of two years in an analyst role required, preferably in the healthcare industry.

2. Advanced Excel skills required, that include working with large data sets, creating standardized reports, utilizing vLookups and advanced functions/ formulas; creating, using and interpreting pivot tables, filtering and formatting.

3. Preferred work experience with SAS and/or SQL to create queries, pull large data sets and perform data manipulations/analysis

4. Preferred experience with ICD codes, medical claims, Medicare Advantage and Commercial/ACA products.