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Risk Adjustment Analyst (Seattle, WA)* Provide support for both projects and processes related to departmental and divisional decision-making. Assist with the development of performance assessment tools. Prepare analysis and reports for the development of effective financial management strategies including cost, utilization, quality, and product recommendations. Participate in organizational compliance and coding initiatives and processes related to the implementation and integration of Risk Adjustment. Cultivate healthcare data expertise by attending out of state and national conferences. Educate outside colleagues about the function of Risk Adjustment. Mentor, train and coordinate work of Risk Adjustment staff. * Consult with customers to fully understand system requirements and needs for Risk Adjustment. Confirm data analysis requests and timelines. Extract, synthesize and model data. Analyze and evaluate the data to create useful strategic information for the formulation of departmental and divisional recommendations. Participate in Cooperative wide customer driven project teams. Consult with customers to integrate tools with overall work processes. Make necessary system enhancements to provide benefits to a wider customer base. * Provide data expertise, training and consultation to internal managers and users as well as external data requestors of Risk Adjustment information. Network and collaborate with peers and other staff to share knowledge and provide necessary and specific departmental and/or divisional Risk Adjustment expertise. Consult on data availability and system limitations. Educate others about the source and use of Risk Adjustment/Assessment models and methodologies. * Maintain a high level of proficiency in end-user computer software, operating systems and other departmental and divisional systems as needed. Provide project management, leadership and lead skills as assigned to departmental and divisional staff. * Develop, improve and maintain various systems for Performance Reporting business processes (e.g. risk assessment, rating and pricing tools, external performance reporting, cost utilization and resource allocation systems and clinical improvement reporting). * Create and maintain a series of related and special population databases. Complete Risk Adjustment reporting application programming. * Lead or participate in risk adjustment revenue enhancement discussions relating to Medicare and other Risk Adjusted accounts. Work closely with DISC, Business Operations and Compliance to ensure the accuracy of Performance Reporting data. QUALIFICATIONS: * Minimum: Knowledge of decision support reporting systems design, structure and data. Proven consulting experience with complex analytical problem solving skills. Strong analytical, conceptual, modeling, communication and customer service skills with the ability to present analysis to both internal and external audiences. Data warehouse, file and database management skills required with the ability to program in both Access and SAS. * Preferred: In-depth understanding of operational systems and practices in managed care setting with extensive knowledge of risk adjustment models and methodologies. Proven understanding of CMS, Medicaid, and PEBB reimbursement methodologies. * Required 3+ years data analysis and reporting duties with prior experience designing large information system reporting applications. 5+ years of prior managed health care experience in underwriting, rating, pricing, or actuarial services preferred. * Bachelor’s degree or equivalent experience required; Master’s degree or equivalent experience preferred. To apply for the position #61216x6285X1879, please visit the Group Health website at: www.ghc.org, Employment Section. Group Health is an Equal Opportunity Employer committed to a diverse and inclusive workforce. This job ad has expired. Click here for active job ads. |
