Senior Risk Adjustment Analyst
$74,602–$126,823 year
On-siteBend, Oregon, United States
Job Summary
Optimize data submission to regulatory entities like CMS for risk-adjustable populations by leveraging applicable risk models to improve Hierarchical Condition Categories, HEDIS, and quality performance. Collaborate with internal and external partners to minimize submission errors, oversee vendor partners, and develop processes for risk adjustment and quality improvement. Lead specified projects with cross-functional teams, interact with provider partners to inform performance, and provide mentorship to less experienced analysts. Identify and analyze risk adjustment trends, maintain existing reports, and develop new reporting capabilities to forecast risk scores and quality metrics. Validate data integrity, run applicable CMS and HHS models, and perform root cause analysis to ensure high data integrity and regulatory compliance.
Required Qualifications
- Five years' experience in data analytics or software development
- At least three years' experience in Health Plan
- In depth risk adjustment and/or HEDIS experience
- Experience with risk models
- Experience with CMS guidelines
- Experience with regulatory data submissions
- Experience with retrospective and prospective programs
- Experience interpreting health care regulatory/accreditation requirements
- Experience with data validation audits
- Expertise in Microsoft Excel
- Expertise in SAS/SQL
- Experience in leading projects and project teams
- Familiarity with Medicaid risk adjustment
- Familiarity with CMS 5-Star
- Familiarity with Risk Adjustment Documentation
- Familiarity with Coding practices
- Familiarity with NCQA quality metric experience
- Bachelor's degree in Mathematics, Statistics, Health Informatics or similar research related field
- Expert-level analytical and problem-solving abilities
- Mastery of theories and applications of computer programming
- Ability to keep current with changing technologies
- Ability to work independently under limited supervision
- Ability to exercise initiative within established procedural guidelines
- Ability to prioritize work to meet established deadlines
- Excellent communication skills, both verbal and written
- Ability to convey technical information in an accessible and understandable manner
- Ability to establish and maintain effective work relationships
- Ability to exercise good judgement
- Ability to demonstrate decisiveness and creativity
- Ability to read, understand, and interpret documents of complex subject matter
- Ability to communicate clearly and effectively
- Ability to read and comprehend both written and spoken English
- Travel approximately 20% of the time
- Some overnight travel
Desired Qualifications
- Advanced degrees
- Familiarity with Risk Adjustment Documentation
- Familiarity with Coding practices
- Familiarity with NCQA quality metric experience
Hiring someone like this?
Get your role in front of qualified candidates on Sorce.