RISK ADJUSTMENT ANALYST

October, 2018

Reports To: Director, Population Analytics Job Code: MM6021

Department: Population Analytics Exemption Status: Exempt

Location: Main Office Remote Eligible: N

Direct Reports: None

JOB SUMMARY :

At CHPW, analytics translate healthcare data into actionable insights. This role leads the analytic effort for various risk adjustment programs, ensuring a highly functioning end to end process. We are seeking a motivated Risk Adjustment Analyst to join our team, supporting and expanding on CHPWs risk analytic capabilities. This role requires critical thinking, strong communication, a positive attitude, and learning agility.

ESSENTIAL FUNCTIONS :

• Builds, performs, and maintains risk adjustment models and analyses for tracking and reporting at the department, senior leadership, and CHC level.

• Manages the analytic component of complex departmental projects.

• Effectively tracks and monitors performance of retrospective and prospective risk adjustment programs, identifying issues and making recommendations.

• Proposes and implements innovative approaches to creating or improving automation, optimizing department processes where appropriate.

• Maintains compliance with CMS requirements, modeling financial impacts to changes in risk adjustment data and methodologies.

• Supports encounter data reporting processes for EDPS, RAPS and the EDGE server, including tracking, reporting, and resolving rejections. Conducts gap analysis and data validation, identifying possible issues in data submission and determining financial impact.

• Works directly with IS&T, Operations and external vendors to ensure submission of accurate and complete risk adjustment data.

• Provides decision support for department, including data requests for financial statements accruals, bids, and budget.

• Leads projects/initiatives owned by Population Health Management that span departments and hold accountability for project/initiative success.

• Conducts complex quantitative analyses using tools such as SQL, SAS, Access, and Excel.

• Completes ad hoc analyses to support internal and external customers

• Exhibits 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.

• Exempt Employees are expected to report to work as scheduled, participate in all assigned meetings, and meet established performance and accountability standards.

• Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.

QUALIFICATIONS :

Education

· Bachelors degree in a quantitative discipline such as Mathematics, Statistics, Actuarial Science or Economics required.

EXPERIENCE

· 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

EMPLOYMENT ELIGIBILITY

· Complete and successfully pass a criminal background check

· Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency

KNOWLEDGE, SKILLS, AND ABILITIES

· 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 & 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.

· Meet attendance and punctuality standards

· Demonstrate professional courtesy to others and ability to maintain confidentiality

SENSORY/PHYSICAL/MENTAL REQUIREMENTS

SENSORY* :

· Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.

PHYSICAL* :

· Extended periods of sitting, computer use, talking and possibly standing

· Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion

· Frequent torso/back static position; occasional stooping, bending and twisting

· Some kneeling, pushing, pulling, lifting and carrying (not over 25 pounds), twisting and reaching

MENTAL :

· Must have the ability to learn and prioritize multiple tasks within the scope and guidelines of the position and its applicable licensure requirements, many requiring extremely complex cognitive capabilities. Must be able to manage conflict, communicate effectively and meet time-sensitive deadlines.

WORK ENVIRONMENT

Office environment with frequent environmental exposure to low-grade radiation from computer monitors; fast paced with frequent interruptions.

PROTECTED HEALTH INFORMATION (PHI) ACCESS

All information (written, verbal, electronic, etc.) that an employee encounters while working at CHPW is considered confidential. CHPW employees may encounter protected health information in the regular course of their work at and for CHPW. This position may be exposed to and required to deal with highly confidential and sensitive material and must adhere to CHPW policies, guidelines, and all applicable laws and regulations at all times.

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*Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.

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This job description is intended to describe the general content and the requirements for satisfactory performance in this position. It is not to be construed as an exhaustive statement of the duties, responsibilities or requirements of this position.

COMMUNITY HEALTH PLAN OF WASHINGTON IS AN EQUAL OPPORTUNITY EMPLOYER COMMITTED TO A DIVERSE AND INCLUSIVE WORKFORCE. ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION FOR EMPLOYMENT WITHOUT REGARD TO ANY ACTUAL OR PERCEIVED PROTECTED CHARACTERISTIC OR OTHER UNLAWFUL CONSIDERATION.