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Data Analyst, Risk Adjustment

POSITION PURPOSE:
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 CHPW’s risk analytic capabilities. This role requires critical thinking, strong communication, a positive attitude, and learning agility.

PRINCIPAL DUTIES:
• 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.
• Other duties as assigned.

QUALIFICATIONS:
Education
• Bachelor’s degree in a quantitative discipline such as Mathematics, Statistics, Actuarial Science or Economics required.

Prior Related Experience
• Minimum two (2) years experience analyzing healthcare claims/encounter data required, five (5) years preferred.
• Extensive experience with advanced analytic features of SQL, Access and Excel.
• Proven 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:
• Candidate 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
• Demonstrated 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.

Apply for Data Analyst, Risk Adjustment using the link below:
https://workforcenow.adp.com/jobs/apply/posting.html?client=chpwadp&jobId=167564&lang=en_US&source=CC3

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.

Time:  Full time
Salary:  Salary
Category:  Network management

Updated: 1/9/2017 3:57:38 PM