Risk Adjustment Analyst

3 days ago

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

At Community Health Plan of Washington, we are seeking a highly skilled Risk Adjustment Analyst to join our team. As a key member of our analytics team, you will play a critical role in leading the analytic effort for various risk adjustment programs, ensuring a highly functioning end-to-end process.

Key Responsibilities
  • Build, perform, and maintain risk adjustment models and analyses for tracking and reporting at the department, senior leadership, and provider level.
  • Manage the analytic component of complex departmental projects, including data analysis, modeling, and reporting.
  • Effectively track and monitor performance of retrospective and prospective risk adjustment programs, identifying issues and making recommendations.
  • Propose and implement innovative approaches to creating or improving automation, optimizing department processes where appropriate.
  • Maintain compliance with CMS requirements, modeling financial impacts to changes in risk adjustment data and methodologies.
  • Support encounter data reporting processes for EDPS, RAPS, and the EDGE server, including tracking, reporting, and resolving rejections.
  • Conduct gap analysis and data validation, identifying possible issues in data submission and determining financial impact.
  • Work directly with IS&T, Operations, and external vendors to ensure submission of accurate and complete risk adjustment data.
  • Provide decision support for department, including data requests for financial statements accruals, bids, and budget.
  • Lead projects/initiatives owned by Population Health Management that span departments and hold accountability for project/initiative success.
  • Conduct complex quantitative analyses using tools such as SQL, SAS, Access, and Excel.
  • Complete ad hoc analyses to support internal and external customers.
  • Exhibit initiative in exploring and discovering opportunities to improve corporate performance through data analysis.
  • Presents analyses/reports in clear and useful format to management and colleagues in other departments.
Requirements
  • Bachelor's degree in a quantitative discipline such as Mathematics, Statistics, Actuarial Science, or Economics or equivalent combination of education and highly relevant experience required.
  • Minimum two (2) years of experience analyzing healthcare claims/encounter data required.
  • Extensive experience with advanced analytic features of SQL, Access, and Excel.
  • Analytical and quantitative skills, including experience with managing and modeling of large data sets.
  • Experience with Commercial, Medicare, and/or Medicaid Risk Adjustment models preferred.
Preferred Qualifications
  • Ability to interpret healthcare data and effectively present sophisticated analyses and findings to both subject matter experts and lay audiences.
  • Adept at queries, report writing, and presenting findings.
  • Knowledge of risk adjustment payment methodologies.
  • Thorough knowledge of healthcare coding conventions such as ICD-10, CPT, and HCPCS.
  • Experience with Medicare Advantage, Medicaid, and/or Commercial reporting.
  • Project management skills.
  • Ability to take full ownership of projects, meeting scheduled deadlines with minimal supervision.
  • Strong attention to detail.
  • Sharp and thoughtful in approach.
  • Excellent oral and written communication skills.
  • Excellent customer service skills.
  • Ability to maintain a professional demeanor and confidentiality.

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