Senior Analyst, Risk Adjustment

Curana Health, Inc.

82d

About The Position

The Senior Risk Adjustment Analyst will collaborate and coordinate with internal and external partners to complete delegated and ad hoc analyses, accumulate and report out on pertinent data sets, perform end to end data reconciliations, develop and improve processes related to risk adjustment, maintain required documentation, and ensure compliance within all applicable laws, guidance, and regulations. This position leverages the available tools, technology, and knowledge of the applicable risk models to ensure complete and accurate wellness profiles of our membership. This includes interaction with leadership with the intent of informing them on key performance indicators and other metrics to help drive strategic decisions and business initiatives.

Requirements

• Bachelor’s Degree (BA/BS) required.
• 5+ years of Risk Adjustment experience within the healthcare space or risk adjustment focused vendor.
• Strong technical acumen and analytical skills required, including high proficiency in Excel and SQL.
• Strong verbal and written communication with proven experience developing executive-facing presentations or other deliverables.

Nice To Haves

• Familiarity and experience with value-based care concepts and payment models (e.g., ACOs, Medicare Advantage) preferred.
• AAPC or AHIMA coding certification is a plus.
• PTT and/or PowerBI experience preferred, but not required.

Responsibilities

• Recommend and guide process improvements that will capture accurate risk adjustment factor increases while mitigating inaccurate capture of disease burden.
• Identify, analyze, interpret and communicate risk adjustment trends to provider partners and related entities through detailed/summary reports and presentations.
• Responsible for maintenance of existing reports and development of new reports to help ensure company goals are met, as well as other ad hoc requests as needed.
• Develop and maintain data sets leveraging internal data, response files from regulatory entities (MMR, MOR, RAPS response, EDPS, MAO-002, MAO-004, etc.), and ancillary data sources to be consumed across the enterprise.
• Understand the various risk models, risk score build-up, and Medicare Risk Adjustment calendar.
• Maintain strict oversight of vendors and plan partners through analytical reconciliations to ensure regulatory compliance, optimal data submissions and error resolution, and general accuracy.
• Assist with all pertinent audits, including RADV, through preparation activities and documentation.
• Perform root cause analyses to maintain high integrity data and processes to minimize discrepancies and gaps.
• Maintain a high level of familiarity of current CMS regulations and announcements affecting risk adjustment.
• Develop, maintain, and report out on actionable metrics related to risk adjustment and incorporate quality/health outcome metrics where applicable.
• Provide support as needed for projecting annual receivable amounts, preparing projections related to pricing efforts, and predicting cost utilization as it relates to risk adjustment.
• Work with changing data, file specifications, and internally coordinate releases and modifications through approved procedures.
• Collaborate with internal and external partners to resolve data issues related to member, claim, provider and pharmacy data and processes.
• Work with internal teams, plan partners, and vendors as needed to support risk adjustment activities.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Bachelor's degree