Senior Risk Adjustment Analyst

Senior Risk Adjustment Analyst page is loaded## Senior Risk Adjustment Analyst locations:
Springfield, ORtime type:
Full time posted on:
Posted Todayjob requisition :
2026-59
* Join Pacific Source and help our members access quality, affordable care!
*** Pacific Source is an equal opportunity employer.  All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age.
** Pacific Source values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.

The Senior Risk Adjustment (RA) Analyst assists in the accurate and comprehensive data submission to regulatory entities such as the Centers for Medicare & Medicaid Services (CMS) for all risk adjustable populations. This position leverages available tools and knowledge of the applicable risk models to optimize data submission as it pertains to Hierarchical Condition Categories (HCCs), HEDIS and Quality performance as well as other data within a given system.

The Senior RA Analyst will collaborate and coordinate with internal and external partners to minimize submission and response errors, provide thorough oversight of vendor partners, accumulate, and report out on pertinent data sets, develop and improve processes related to risk adjustment and quality improvement, maintain required documentation, and ensure compliance to all applicable laws, guidance, and regulations. Assume lead role on specified projects.

Projects are completed with cross-functional teams of peers and business partners. This includes interaction with provider partners with the intent of informing them on performance and educating on best practices in risk adjustment. The Senior RA Analyst will provide mentorship to less experienced team members. In addition, this position influences decision making by leadership and provides recommendations regarding potential improvements to risk adjustment processes and outcomes.
*
* Essential Responsibilities:

*** Recommend and guide process improvements that will optimize risk adjustment factor increases while minimizing inaccurate capture of disease burden.
* Identify, analyze, interpret and communicate risk adjustment trends to be consumed by provider partners and related entities.
* Responsible for maintenance of existing reports, development of new reports to help ensure company goals are met, as well as other ad hoc requests as needed.
* Develop and maintain reporting capabilities to measure and forecast risk scores & quality metrics, monitor suspecting model performance, and identify areas of improvement
* Maximize risk adjustment revenue and quality bonus payments by driving data integration and analytics to properly capture and improve the health status of Pacific Source members.
* Validate data integrity and collaborate with technical teams to improve data pipelines and business logic for identified areas of opportunity
* Identify and lead internal subject matter experts in regular meetings to identify and rectify various data submission and adjudication errors related to risk adjustment and quality data submission.
* Develop and maintain data sets leveraging internal data, response data from regulatory entities (including but not limited to: EDGE files, MMR, MOR, RAPS Response, MAO-004, PSV, PLD, etc.), and ancillary data sources to be consumed across the enterprise.
* Demonstrate mastery in running all applicable risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA members, and others as needed.
* Maintain strict oversight of vendor partners through analytic reconciliations to ensure regulatory compliance, optimal data submission and error resolution, and general accuracy.
* Assist with all pertinent audits, including RADV,…