Risk Adjustment Analyst

Position: — Risk Adjustment Analyst
# Risk Adjustment Analyst

Requisition :
186123

Department:
500618 Risk Adjustment

Shift:
Day Category:
Professionals### Paid Time Off### 401(k) Company Match### Flexible Work Environment Renown Health is northern Nevada's healthcare leader and Reno's only locally owned, not-for-profit health system. We are an entire network of hospitals, primary care offices, urgent care centers, lab services, medical specialties, and x-ray and imaging services - with more than 7,000 nurses, doctors and care providers dedicated to the health and well-being of our community.
** For Providers:
** Renown Health and the University of Nevada, Reno School of Medicine (UNR Med) are affiliate partners in Nevada's first integrated academic health system. The affiliation aims to improve the health of the community, region, and state through research, medical education, and expanded clinical care. Renown physicians participate as joint faculty at UNR Med for teaching, lectures, supervising clinical rotations, and other academic activities for the education of medical and physician assistant students, residents and fellows.

Schedule:

Full Time - Eligible for Benefits## Position Purpose The Risk Adjustment Analyst is responsible for supporting the Medicare Advantage and Commercial Risk Adjustment programs through the end-to-end processes of data management and data submissions. This will be accomplished through designing, building and automating reporting analysis and modeling by utilizing a variety of systems. The position helps to create visibility of the risk adjustment initiatives by measuring project success, KPI development and goal tracking.

Along with providing analytical support for the risk adjustment initiatives, the analyst will assist in developing and implementing systems, processes and standards to ensure the risk scores appropriately reflect the disease burden of each member.## Nature and Scope This position develops and coordinates the risk adjustment improvement and reporting efforts, for Hometown Health’s Medicare and Commercial products utilizing a variety of source systems and development tools.

Included within the scope of this position, the analyst will perform data extraction, analysis, report design, report build, solution deployment, and draft documentation to support the Financial and Business reporting solutions for Hometown Health. Accurate and timely project status feedback is expected to ensure compliance with established timelines.
** KNOWLEDGE, SKILLS & ABILITIES:
** 1. Perform analysis and reporting activities relating to: risk score calculation, claims/encounters data submission, chart review programs, audits, and related performance metrics.
2. Participate in the development of requirements, testing and refinement of the underlying data and systems.
3. Collaborate with other business units to deliver reports/updates on underlying data and systems as used by the Risk Adjustment team.
4. Analyze data flow and data integrity to identify areas for improvement.
5. Understand and advise on CMS risk score methodology, including risk score calculation, hierarchical condition categories (HCCs), financial risk receivable calculations, RAPS and EDS processes and key regulator deadlines for data submission, RAPS and EDS Return Files and Error Files, ICD coding, claims, and provider data.
6. Operate risk adjustment analytic vendor platforms to assist with intervention tracking, monitoring, analysis and reporting of diagnosis codes that drive risk score calculations.
7. Work cross functionally across multiple departments to design and develop financial dashboards, KPIs, and models to identify and track profit/loss and ROI trends.
8. Collaborate with Risk Adjustment Coders and Risk Adjustment Nurses to build internal projects based on diagnosis code, procedures, etc. trends for prospective and/or retrospective review.
9. Contribute to developing materials and presenting key updates to Senior Leadership regarding risk adjustment programs and provider and member engagement initiatives.

This position does not provide patient care### Disclaimer The foregoing description is not intended and should not be construed to be…