Career Opportunities: Risk Adjustment Analyst (24959)

Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin.

Job Summary

The Risk Adjustment Analyst performs data extraction, conducts data analysis, and prepares various production and ad hoc reports aligned with risk adjustment initiatives and strategies for both the Medicare and Medicaid lines of business. This position provides recommendations regarding potential improvements to risk scores and risk-related processes. 

Essential Responsibilities

Reporting

• Provide dashboards, reports, and analysis related to risk adjustment activities.
• Prepare annual receivable estimate for final risk adjustment payment from CMS.
• Use statistical software, including SAS, to retrieve, edit and tabulate data from databases and files.
• Prepare actionable clinic reporting that identifies members with risk adjustment opportunities.
• Use the company’s data aggregator to produce reports and lists that support efforts to optimize risk scores.

Analysis

• Conduct trend analysis to identify process improvements related to coding and documentation.
• Gain knowledge of and perform financial analysis related to risk score improvements.
• Evolve technical skills in analyzing risk adjustment data, learning how to assess its quality, validity and reliability.
• Calculate risk scores and risk score related reporting for both the Medicare and Medicaid lines of business by compiling data and executing the risk adjustment models.
• Study and analyze tables, graphs, charts and other statistics; report results in a variety of formats.
• Assist in the reconciling of CMS payments monthly.

Consulting

• Recommend process improvements that will benefit risk adjustment factor increases with avoidance of inaccurate plan payments.
• Assist with RADV preparation activities and audits.
• Work with outside vendors as needed.

Organizational Responsibilities

• Perform work in alignment with the organization’s mission, vision and values.
• Support the organization’s commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
• Strive to meet annual business goals in support of the organization’s strategic goals.
• Adhere to the organization’s policies, procedures and other relevant compliance needs.
• Perform other duties as needed.

Experience and/or Education

Required

• Minimum 2 years’ related experience, including report development and programming

Preferred

• Bachelor’s degree in Statistics, Mathematics, Business, Technology or a related field

Knowledge, Skills and Abilities Required

Knowledge

• Proficient knowledge of statistical software packages, such as SAS
• Knowledge of SAS macros

Skills and Abilities

• Ability to gather, interpret and analyze data using statistical methods with minimal review
• Ability to extract data from databases using such software tools
• Ability to design and run intermediate to complex queries and reports
• Ability to manipulate and analyze statistical data
• Ability to prepare narrative and statistical reports
• Ability to identify trends, problems, and opportunities for improvement
• Intermediate skills with spreadsheets and word processing applications
• Strong written and verbal communication skills
• Growing ability to effectively convey ideas and concepts
• Ability to manage multiple tasks

• Ability to work effectively with diverse individuals and groups

• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see for at least 6 hours/day
• Ability to read, hear, speak clearly, and perform repetitive finger and wrist movement for at least 3-6 hours/day

Working Conditions

Work Environment(s):   ☒ Indoor/Office    ☐ Community      ☐ Facilities/Security     ☐ Outdoor Exposure

Member/Patient Facing:    ☒ No                          ☐ Telephonic        ☐ In Person

Hazards:  May include, but not limited to, physical and ergonomic hazards.

Equipment:  General office equipment

Travel:  May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used.

Work Location: Work from home

#LI-Remote

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment.

Veterans are strongly encouraged to apply.

We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.

Visa sponsorship is not available at this time.