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Medicare Risk Adjustment Specialist

2 months ago

Topeka, Kansas, United States Kansas Action for Children Full time

Position Overview

Kansas Action for Children is seeking a dedicated professional to fill the role of a Risk Adjustment Analyst. This pivotal position involves the accurate reporting of Medicare Advantage (MA) risk adjustment data to leadership and regulatory bodies, ensuring compliance and optimal performance in risk adjustment initiatives.

Key Responsibilities

  • Maintain expert knowledge of CMS ACA/MA risk adjustment program requirements and methodologies.
  • Review and interpret CMS communications regarding ACA/MA risk adjustment, recommending necessary policy adjustments.
  • Ensure timely and precise ACA/MA risk adjustment reporting to CMS, adhering to both internal and federal guidelines.
  • Utilize reporting and modeling tools to enhance compliance and revenue optimization.
  • Conduct thorough analysis of RAPS/EDPS files to reconcile submissions with CMS specifications, collaborating with vendors and internal teams to rectify discrepancies.
  • Support data analysis for annual audits and engage in HEDIS data analysis, including audits and statistical evaluations.
  • Contribute to the creation of educational materials for providers related to ACA/MA risk adjustment.
  • Participate in the ACA/MA Risk Adjustment Data Validation (RADV) audit process, ensuring compliance with CMS standards.
  • Analyze risk performance trends to inform strategic development and improvement initiatives.

Why Consider This Opportunity?

This role offers a chance to make a significant impact on the health and well-being of children and families in Kansas. With a commitment to professional growth, Kansas Action for Children provides ongoing training and development opportunities, fostering a culture of inclusivity and respect.

Work Environment

This position supports a hybrid work model, allowing for flexibility while maintaining a collaborative team environment.