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Risk Adjustment Analyst

Location: Portland, OR 97205
Posted On: 06/22/2022
Requirement Code: 59188
Requirement Detail

Staffing Technologies has partnered with a keystone business located in Portland, Oregon!  With a people first business model and a culture of volunteerism, this robust business provides a nurturing, inclusive and stable work environment to grow with for the long-term.  Offering products that support and sustain healthy living, this established business operates in 5 states with plans for future expansion.  As a Risk Adjustment Analyst you'll have the opportunity to play a critical role with the business to ensure adequate compensation for risk assumed in Medicare and ACA Markets, while improving the experience of both the member and the care team, through sophisticated analysis and communication of HCC and other health care data. 

 

Primary Functions:


  • Under general supervision, performs complex research and analysis of healthcare claims, enrollment, and other related data, to report on network utilization, cost structure, and/or quality. 
  • Builds, performs, and maintains risk adjustment models and analyses for tracking and reporting at the department, senior leadership, and provider level.
  • Effectively tracks and monitors performance of retrospective and prospective risk adjustment programs, identifying issues and making recommendations
  • Exhibits initiative in exploring and discovering opportunities to improve corporate performance through data analysis
  • Presents data in a compelling way that highlights the opportunities at hand - whether in making comparisons to benchmarks, pointing out anomalies, displaying trends over time, or using other creative analytical tools.
  • Thinks creatively about how to solve ad hoc reporting problems or meet specific business needs, given the data available.
  • Meets with internal customers to brainstorm what kind of information/report is needed for each situation.
  • Makes presentations to internal and external stakeholders about health care risk, cost, and utilization. 
  • Writes and maintains documentation related to reports and projects.
  • Participates in work groups and committees as needed.
  • Collaborates with the other members of the Risk Adjustment Process Team to expand analytical capabilities, methods, and toolkits.
  • Participates in user groups to share analysis tips and techniques.

Required Skills


  • Bachelor's degree or equivalent experience.
  • Minimum 3 years' experience in financial analysis or other data analysis role. Experience with health care data preferred. Experience with Medicare Advantage and ACA Risk Adjustment data highly preferred.
  • Understanding of health care data sources and limitations.
  • Ability to transform and integrate data from multiple tables, databases, and/or systems.


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