Healthcare Risk Analysis Specialist

1 week ago

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

Risk Adjustment Analyst

Job Category: Accounting & Finance

Requisition Number: RISKA001587

Job Details

Overview:

At Community Health Plan of Washington, we leverage analytics to transform healthcare data into meaningful insights. We are looking for a dedicated Risk Adjustment Analyst to spearhead our analytic initiatives across various risk adjustment programs, ensuring a seamless end-to-end process. This position demands critical thinking, effective communication, a proactive mindset, and a willingness to learn.

Key Responsibilities:

  • Develop, execute, and sustain risk adjustment models and analyses for performance tracking and reporting at various organizational levels.
  • Oversee the analytic aspects of intricate departmental projects.
  • Monitor and evaluate the effectiveness of retrospective and prospective risk adjustment programs, identifying challenges and proposing solutions.
  • Innovate and implement strategies to enhance automation and optimize departmental processes.
  • Ensure adherence to CMS regulations, assessing financial implications of changes in risk adjustment data and methodologies.
  • Support encounter data reporting processes, including tracking, reporting, and addressing discrepancies.
  • Collaborate with IT, Operations, and external partners to guarantee the accurate submission of risk adjustment data.
  • Provide analytical support for departmental needs, including data requests for financial reports, bids, and budgets.
  • Lead cross-departmental projects and initiatives within Population Health Management, ensuring accountability for their success.
  • Conduct complex quantitative analyses utilizing tools such as SQL, SAS, Access, and Excel.
  • Perform ad hoc analyses to assist both internal and external stakeholders.
  • Demonstrate initiative in identifying opportunities for enhancing corporate performance through data analysis.
  • Present findings and reports in a clear and actionable format to management and colleagues across departments.

Qualifications:

Education:

Bachelor's degree in a quantitative field such as Mathematics, Statistics, Actuarial Science, or Economics, or an equivalent combination of education and relevant experience.

Experience:

A minimum of two years of experience in analyzing healthcare claims or encounter data is required. Proficiency in advanced analytic features of SQL, Access, and Excel is essential. Strong analytical and quantitative skills, with experience in managing and modeling large datasets, are necessary. Familiarity with Commercial, Medicare, and/or Medicaid Risk Adjustment models is preferred.

Employment Eligibility:

Must successfully complete a criminal background check and not be sanctioned or excluded from federal or state healthcare programs.

Knowledge, Skills, and Abilities:

  • Ability to interpret healthcare data and effectively communicate complex analyses to diverse audiences.
  • Proficient in query writing, report generation, and presenting findings.
  • Understanding of risk adjustment payment methodologies and healthcare coding conventions such as ICD-10, CPT, and HCPCS.
  • Experience with Medicare Advantage, Medicaid, and/or Commercial reporting.
  • Strong project management skills with the ability to independently manage projects and meet deadlines.
  • Attention to detail and a thoughtful approach to problem-solving.
  • Excellent oral and written communication skills, along with strong customer service abilities.
  • Ability to maintain professionalism and confidentiality in all interactions.

Work Environment:

This position is based in an office environment with exposure to standard office equipment and a fast-paced atmosphere with frequent interruptions.

Equal Opportunity Employer:

Community Health Plan of Washington is an equal opportunity employer and values diversity in the workplace.

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