CareOregon Hiring For Sr Risk Adjustment Analyst at Portland, OR  Full Time

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

Job Title	Sr Risk Adjustment Analyst
Exemption Status	Exempt
Department	Finance
Manager Title	Risk Adjustment Manager
Direct Reports	n/a
Requisition #	23480
Pay and Benefits	Estimated hiring range $94,320 – $114,125, 5% bonus target, full benefits. To learn more about our benefits, please visit

Job Summary

The Senior Risk Adjustment Analyst performs data extraction, conducts advanced 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 influences leadership decision making and 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 various 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.
• Perform advanced financial analysis related to risk score improvements.
• Analyze risk adjustment data and 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 and report results in a variety of formats.
• Assist in the reconciling of CMS payments monthly.

Consulting

• Advise on and guide process improvements that will optimize risk adjustment factor increases with avoidance of inaccurate plan payments.
• Assist with RADV preparation activities and audits.
• Work with outside vendors as needed.
• Advise internal customers regarding the availability and utility of data elements for reporting and data set requests, as well as the timing and frequency of reporting and data refresh.
• Help determine the need for additional risk adjustment tools and resources.

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 5 years’ related experience, including report development and programming

Preferred

• Bachelor’s degree in Statistics, Mathematics, Business, Technology, or a related field
• Experience using SAS in a health care environment
• Experience with Medicare Advantage and OHA risk adjustment and payment methodologies
• Experience with medical claims analysis

Knowledge, Skills and Abilities Required

Knowledge

• Advanced knowledge of statistical software packages, such as SAS
• Knowledge of and ability to run CDPS + Rx model, risk adjustment methodology and OHP encounter data
• Knowledge of SAS macros
• Knowledge of Medicare and Medicaid programs
• Knowledge of medical and/or pharmacy claims
• Knowledge of financial matters in the health care industry
• Knowledge of and ability to run CMS HCC models, risk adjustment methodology, RAPS, and EDPS preferred

Skills and Abilities

• 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
• Excellent written and verbal communication skills
• Ability to effectively convey concepts and influence leadership decision making
• 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

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.

#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.

Equal opportunity employer. This company considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.