SeniorRisk Adjustment Analyst

Description:

Providence Health Plan is calling a Senior Risk Adjustment Analyst to our location in Portland, OR. This position has the option of being fully remote or in-office based out of our Portland or Beaverton, Oregon locations.

We are seeking a Senior Risk Adjustment Analyst who will be responsible for designing, implementing, and coordinating complex quality improvement and process management initiatives. Also responsible for leading advanced strategic analysis of revenue, medical expense, and population risk assessments and adjustments for multiple geographic regions and lines of business.

Specifically, the Senior Risk Adjustment Analyst supports the complete and accurate capture of conditions for members enrolled in government programs, maintaining compliance with CMS standards, ensuring the Company receives the appropriate reimbursement to help cover the conditions of enrollees; leads business data operations by designing statistical methods that provide insight into the coding practices of providers; implements data systems for the analysis of Medicare and ACA Risk Adjustment diagnoses; models financial impacts of changes in risk adjustment data and methodologies; collaborates regularly with internal departments and external vendors on risk adjustment projects; gathers, standardizes and consolidates financial claims, membership and premium data into SAS data sets used for risk adjustment analytical and reporting needs; leverages industry resources to increase knowledge and improve ROI of risk adjustment activities; and analyzes the impact of Risk Adjustment Programs identifying process improvements and opportunities to achieve efficiency and effectiveness. Successful candidates will be seasoned data/finance analysts with experience working in the CMS-HCC and/or HHS-HCC Risk Adjustment Models and be knowledgeable of CMS payment files and Risk Adjustment data.

In this position you will have the following responsibilities:

• Provide advanced quantitative and statistical analyses for quality, clinical, and operational improvement activities supporting Finance, Provider Contracting, Product Development, and Medical Coding Administration. Includes effectively summarizing complex information into appropriate charts, tables, and figures to convey the meaning of the data to customers and decision-makers.
• Prepare reports for provider contract reconciliations and an estimate of the plan's provider incentive liability.
• Prepare financial analysis for new products, product lines, and new service areas.
• Collect, organize, validate, and analyze data for risk adjustment revenue analytics and SQL model development that support operational decision making.
• Build, publish, and maintain reports of Hierarchical Condition Category (HCC) capture with key insights into disease prevalence and potential coding gaps.
• Develop regular and ad hoc reports to supplement risk adjustment processes through query building and data extraction, including monthly risk adjustment revenue accruals.
• Build reports and dashboards to track risk adjustment related projects and track the effectiveness of the initiatives.
• Prepare supporting documentation needed for financial statements, statutory reporting and Federal MLR filings.
• Understand and interpret the key drivers of health care trends; projecting expected revenue and cost.
• Analyze forecasts and trends to help leaders make decisions.
• Monitor CMS guidance and calls for required compliance and system or process changes. Work with management on design and implementation of the changes.
• Participate in the writing, implementation, and monitoring of policies and procedures to demonstrate internal (MAR) and external (CMS) audit readiness.
• Provide project management for large-sized projects.

Qualifications:

Required qualifications for this position include:

• Bachelor's Degree in a highly quantitative field (e.g. Statistics, Mathematics, Actuarial Science, Economics, Engineering/Physics, Accounting, or Computer Science), plus a minimum of 7 years of experience in data analysis -OR- High School Education or equivalent, plus a minimum of 9 years of experience in data analysis.
• In-depth knowledge of principles, practices, and theories in own professional discipline.
• Project management skills; designs solutions for internal/external clients.
• Considered a resource for others.
• Advanced computer skills (e.g. Microsoft Office and Microsoft SQL-Server). Knowledge of SQL and VB/VBA programming. Relational database skills.

Preferred qualifications for this position include:

• Master's Degree
• Healthcare organization/health insurance experience.
• Advanced knowledge & understanding of risk adjustment in healthcare including common risk adjustment models (i.e., CMS-HCC, HHS-HCC and CDPS Rx)
• Understanding of managed care and health care data sources, including common coding standards (i.e., ICD-10, CPT/HCPCS).
• Experience working with multiple data systems and multiple data reporting tools.
• Knowledge of Tableau or other data visualization software.
• Excellent written and verbal communication skills with an ability to interpret and communicate analytical information to both individuals and groups in a clear and concise manner.
• Demonstrated ability to work effectively, both independently and in a team setting, with individuals having diverse professional backgrounds including business, technical and/or clinical.

About the department you will serve

The Informatics Department at Providence Health Plan is made up of several teams including Actuarial and Underwriting Analytics, Provider Network Analytics, Governmental Revenue Analytics, Pharmacy Analytics, Medical Economics, Clinical Quality Analytics, Operational Analytics, Employer Group Reporting, and Business Intelligence. Informatics provides financial, clinical, and operational analytic support to Senior Leadership in support of Health Plan operations. We are focused on supporting our Mission by delivering world class analysis and actionable insights to provide high quality and high value health care to our members and the communities we serve.

As the largest healthcare system and largest private employer in Oregon, Providence offers exceptional work environments and unparalleled career opportunities. At Providence, our quality vision is simple,

"Providence will provide the best care and service to every person, every time."

Providence is consistently ranked among the top 100 companies to work for in Oregon.

We offer a full comprehensive range of benefits - see our website for details -http://www.providenceiscalling.jobs/rewards-benefits

We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit

https://www.providenceiscalling.jobs/rewards-benefits/

Our Mission

As expressions of God's healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.

About Us

Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

Schedule: Full-time

Shift: Day

Job Category: Infrastructure

Location: Oregon-Portland

Other Location(s): Montana, California, New Mexico, Oregon, Washington, Texas, Alaska

Req ID: 361763