Risk Adjustment Analyst

CareOregon; Portland (OR); Remote; USD 79,000 - 98,000; Full time

Job summary

An established industry player is seeking a Risk Adjustment Analyst to join their innovative team. This fully remote role offers the opportunity to perform data extraction, conduct thorough analysis, and prepare insightful reports aligned with Medicare and Medicaid risk adjustment initiatives. You'll be instrumental in improving risk scores and processes while collaborating with diverse groups. If you're passionate about data and eager to make a meaningful impact in the healthcare sector, this position is perfect for you. Join a company committed to diversity and inclusion, where your contributions will help shape the future of healthcare analytics.

Qualifications

• At least 2 years of related experience in report development and programming.
• Proficiency with SAS and knowledge of SAS macros.

Responsibilities

• Provide dashboards, reports, and analysis related to risk adjustment activities.
• Conduct trend analysis for process improvements.
• Recommend process improvements to increase risk adjustment factors.

Skills

Data Analysis

SAS Proficiency

Statistical Software

Communication Skills

Report Development

Education

Bachelor’s Degree in Statistics

Bachelor’s Degree in Mathematics

Bachelor’s Degree in Business

Bachelor’s Degree in Technology

Tools

SAS

Job description

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

Job Title

Risk Adjustment Analyst

Department

Finance

Exemption Status

Exempt

Requisition #

24959

Direct Reports

N/A

Manager Title

Risk Adjustment Analytics Manager

Pay & Benefits

Estimated hiring range $79,430 - $97,080/year, 5% bonus target, full benefits. More info

Posting Notes

This role is fully remote but must reside in Oregon or SW Washington.

Job Summary

The Risk Adjustment Analyst performs data extraction, conducts data analysis, and prepares various reports aligned with risk adjustment initiatives for Medicare and Medicaid. Provides recommendations for improving risk scores and processes.

Essential Responsibilities

1. Provide dashboards, reports, and analysis related to risk adjustment activities.
2. Prepare annual receivable estimate for CMS payments.
3. Use statistical software, including SAS, for data retrieval and analysis.
4. Prepare reports identifying members with risk adjustment opportunities.
5. Use data aggregators to produce reports supporting risk score optimization.

Analysis

1. Conduct trend analysis for process improvements.
2. Perform financial analysis related to risk scores.
3. Assess quality, validity, and reliability of risk adjustment data.
4. Calculate risk scores for Medicare and Medicaid using risk adjustment models.
5. Analyze data and report results in various formats.
6. Assist in reconciling CMS payments monthly.

Consulting

1. Recommend process improvements to increase risk adjustment factors.
2. Assist with RADV activities and audits.
3. Collaborate with outside vendors as needed.

Organizational Responsibilities

• Align work with the organization’s mission and values.
• Support diversity, equity, and inclusion initiatives.
• Meet annual business and strategic goals.
• Follow organizational policies and compliance requirements.
• Perform additional duties as needed.

Minimum Requirements

• At least 2 years of related experience, including report development and programming.

Preferred Qualifications

• Bachelor’s degree in Statistics, Mathematics, Business, Technology, or related field.

Knowledge, Skills, and Abilities

• Proficiency with SAS and knowledge of SAS macros.
• Ability to analyze data and generate reports.
• Strong communication and interpersonal skills.
• Ability to manage multiple tasks and work effectively with diverse groups.
• Physical ability to perform job functions, including reading and repetitive movements.

Working Conditions

• Indoor/Office environment, work from home.
• May involve occasional travel.
• Physical and ergonomic hazards possible.

CareOregon encourages candidates of color and veterans to apply. They are committed to diversity and inclusion. Visa sponsorship is not available.