at Intermountain Health in Springfield, Illinois, United States
Job Description
Job Description:
The Risk Adjustment Analyst performs data and analytical services in support of optimizing risk adjusted revenue, maintaining compliance with CMS and modeling financial impacts of changes in risk adjustment data and methodologies. This position interacts with analytical\coding staff in all regions, vendors, as well as internal departments such as Finance, Actuarial, Operations, Product Management, Provider Development, Legal, and Compliance. Upper levels of the role also interact with external agencies like ACHP, DOI and CMS as well as outside consultants.
Caregivers in this role will assist in the development of financial projections and conduct analysis for risk adjustment projects including retrospective chart review and prospective initiatives. The Risk Adjustment Analyst gathers, standardizes, and consolidates financial claims, membership and premium data into data sets that are used for risk adjustment analytical and reporting needs. The Analyst should leverage industry resources to increase knowledge and improve ROI of risk adjustment activities.
We will hire at Senior or Staff level depending on qualifications. (see details below)
Unfortunately, we are not currently considering candidates that require visa sponsorship for this position. We apologize for the inconvenience.
Essential Responsibilities/Accountabilities:
Associate:
· Maintains current knowledge of risk adjustment models such as: CMS’ Hierarchical Condition Categories (HCC) and RxHCCs, HHS HCCs, MARA and/or other State Risk Adjustment Models.
· Supports pricing work through estimation of risk scores and associated revenue.
· Participates in regulatory/external party audits and supports RADV analytics.
· Calculates ROI for risk adjustment vendors, initiatives, and projects.
· Supports analysis of regulatory changes in determination of the Health Plan impact.
· Assists in the preparation of risk adjustment analyses.
· Supports higher level analysts on special projects involving other areas of the company.
· Assists in the development of risk scores and other analyses used in the development of financial plans, pricing, forecasting and re-forecasts, and other financial projections.
· Assists in efforts to continually improve data capabilities and quality of department analysis and reporting.
· Develops ad hoc reports to supplement risk adjustment processes through query building and data extraction.
· Highlights downstream impacts of data/system changes (ICD-10 transition, etc.).
· Assists and/or supports other Risk Adjustment teams or Health Plan departments to complete projects or tasks as needed.
· Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are in compliance with these requirements.
· Consistently demonstrates high standards of integrity by supporting the Intermountain Health mission and values, adhering to the Corporate Code of Conduct in helping our members live the healthiest lives possible.
· Maintains high regard for member privacy in accordance with Intermountain privacy policies and procedures.
· Regular and reliable attendance is expected and required.
· Performs other functions as assigned by management.
Staff (in addition to Associate essential responsibilities/accountabilities listed above):
· Shares knowledge with newer department employees.
· Assists in the development of risk adjustment analyses concerning complex issues and trends, and coordinates with staff.
· Works with outside vendors\auditors during implementation and maintenance of key projects.
· Identifies and develops corrective action with regards to Data Warehouse integrity issues.
· Reconciles Data Warehouse data with CMS, HHS and Medicaid response data.
· Initiates and leads efforts to continually improve data capabilities and quality of department analysis and reporting.
· Draws together facts and input from a variety of sources.
· Accountable for loading monthly data marts, updating department specific data tables, and maintaining code that generates the information contained in those data marts and tables.
· Provides decision support in the form of advanced statistical analysis/business intelligence
· Performs advanced programming and statistical analysis/support for ad hoc requests.
· Proposes and assists in development of risk adjustment process improvements and automation of processes utilizing data integration software.
· Participates in on-going training for analytic and business intelligence tools.
Senior (in addition to Staff essential responsibilities/accountabilities):
· Collaborates with the Actuarial Department in the development of risk scores for rate filings. Maintains methods and models or formulas for all lines of business.
· Develops risk adjustment analyses concerning complex issues and trends, coordinating with several different disciplines and staff.
· Manages projects, including development of project plans, tracking and reporting the status of projects, coordination/leading of meetings and presentation of results to management.
· Provides effective technical advice and support to assist management in meeting corporate goals and identifying strategy. Involves other departmental areas as needed.
· Develops and reviews policies and procedures for risk score processing and error resolution.
· Facilitates and educates on existing processes for cross-training and business continuity purposes.
· Fosters an environment of continuous improvement. Constantly explores ways to increase efficiencies and productivity, reducing waste, and reducing costs.
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Minimum Qualifications (Senior – starting at $43.49/hr)
Must meet one of the following:
Bachelor’s degree in an analytics related field such as statistics, mathematics, information systems, computer science, finance, business management, or economics with four years of relevant work experience in a role performing data analysis.
Or
Bachelor’s degree in another area of study with six years of relevant work experience in a role performing data analysis.
Experience without a related degree will be considered if skill set and experience are robust.
Plus:
Demonstration of these skills:
Advanced SQL ability, knowledge of database design, data modeling and standardized data structures
Significant Experience in creating visually appealing, content rich and consumer centric reports and dashboards (i.e. Cognos, Tableau)
Proficiency in using word processing, spreadsheet, internet, e-mail, and scheduling applications
Highly effective verbal, written and interpersonal communication skills
Subject matter expertise in healthcare or related data (Clinical Programs, Clinical Services, Compliance, Quality, Revenue Cycle, Strategic Planning, Population Health, etc.).
Lifelong learner with a creative, collaborative approach.
Temperament to thrive in scaled agile teams (SAFe®) or similar product management practice
Minimum Qualifications (Staff – starting at $39.18/hr)
Must meet one of the following:
Bachelor’s degree in an analytics related field such as statistics, mathematics, information systems, computer science, finance, business management, or economics with two years of relevant work experience in a role performing data analysis.
Or
Bachelor’s degree in another area of study with four years of relevant work experience in a role performing data analysis.
Experience without a related degree will be considered if skill set and experience are robust.
Plus:
Demonstration of these skills:
Intermediate SQL ability, knowledge of database design, data modeling and standardized data structures
Experience creating visually appealing, content rich and consumer centric reports and dashboards (i.e. Tableau, Cognos)
Proficiency in using word processing, spread
