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Healthcare Analytics Consultant

2 months ago

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

Position Title: Risk Adjustment Analyst

Job Category: Accounting & Finance

Job Summary:

At Community Health Plan of Washington, we leverage analytics to transform healthcare data into actionable insights. We are looking for a dedicated Risk Adjustment Analyst to spearhead the analytic initiatives for various risk adjustment programs, ensuring a seamless end-to-end process. This role demands critical thinking, excellent communication skills, a proactive attitude, and a strong willingness to learn.

Key Responsibilities:

  • Develop, execute, and maintain risk adjustment models and analyses for departmental, leadership, and provider-level tracking and reporting.
  • Oversee the analytic aspects of intricate departmental projects.
  • Monitor and evaluate the performance of retrospective and prospective risk adjustment programs, identifying challenges and proposing solutions.
  • Innovate and implement strategies to enhance automation and optimize departmental processes as necessary.
  • Ensure compliance with CMS regulations, modeling financial implications of changes in risk adjustment data and methodologies.
  • Support encounter data reporting processes, including tracking, reporting, and resolving discrepancies.
  • Conduct gap analyses and data validation to identify potential issues in data submissions and assess financial impacts.
  • Collaborate with IS&T, Operations, and external partners to guarantee the submission of accurate and complete risk adjustment data.
  • Provide decision support for the department, including data requests for financial statements, bids, and budget planning.
  • Lead cross-departmental projects/initiatives owned by Population Health Management, ensuring accountability for project success.
  • Perform complex quantitative analyses utilizing tools such as SQL, SAS, Access, and Excel.
  • Conduct ad hoc analyses to assist both internal and external stakeholders.
  • Exhibit initiative in identifying opportunities to enhance corporate performance through data analysis.
  • Present analyses and reports in a clear and effective manner 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.

Knowledge, Skills, and Abilities:

  • Ability to interpret healthcare data and effectively communicate complex analyses and findings to diverse audiences.
  • Proficient in query writing, report generation, and presenting results.
  • 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 and the ability to take ownership of projects, meeting deadlines with minimal supervision.
  • 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 frequent exposure to low-grade radiation from computer monitors. The role is fast-paced and may involve frequent interruptions.

Community Health Plan of Washington is an Equal Opportunity Employer, committed to fostering a diverse and inclusive workplace.