Risk Adjustment and Public Reporting Analyst

Carle Health•Champaign, IL

18d•$31 - $54•Onsite

About The Position

The Risk Adjustment and Public Reporting Analyst is responsible for ensuring the accuracy and validity of risk adjustment methodologies and public reporting readiness. This role involves auditing, analyzing, and validating clinical and administrative data that influence risk-adjusted quality outcomes. The Analyst will collaborate closely with clinical departments, coding teams, and quality management to identify documentation gaps and support compliance with evolving regulatory standards.

Requirements

IHI Open School Basic Certificate in Quality and Safety within 1 year - Institute for Healthcare Improvement (IHI).
Medical Terminology within 1 year.
Certification provided by Carle Health.
Bachelor's Degree: Related Field

Responsibilities

Owns risk-adjustment validity and public reporting readiness, including audits tied to methodology, coding/documentation impact, and regulatory/program change tracking across CMS/Vizient/public programs.
Proactively audit data elements that align with risk adjustment methodologies.
Support analysis and reporting for CMS and other public reporting programs (e.g., Care Compare, Star Ratings, Leapfrog, U.S. News where applicable).
Responsible for exporting, analyzing variations, outliers and opportunity areas and distributing reports form the CMS Hospital Quality Reporting Profile.
Develop reports to support deliverables for a variety of stakeholders.
Work closely with PI Specialist to present findings at opportunity review meetings.
Analyze and validate risk‑adjusted quality measures to ensure accurate representation of patient acuity and organizational performance.
Evaluate the impact of documentation, coding, and comorbidity capture on risk‑adjusted outcomes (e.g., mortality, complications, readmissions).
Collaborate with CDI and Coding teams to identify gaps affecting risk adjustment and quality outcomes.
Perform case‑level and population‑level analyses to support appeals, exclusions, and methodological reviews.
Support analysis and reporting for CMS and other public reporting programs (e.g., Hospital Compare, Star Ratings, Leapfrog, U.S. News where applicable).
Assess the impact of risk adjustment methodologies on publicly reported outcomes.
Track methodological updates and measure changes affecting public reporting programs.