What are the responsibilities and job description for the Associate Risk Adjustment Analyst position at PacificSource Health Plans?
Looking for a way to make an impact and help people?
Join PacificSource and help our members access quality, affordable care!
PacificSource 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, national origin, sex, sexual orientation, gender identity or age.
Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.
The Associate 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) and other data within a given system. The Associate 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, maintain required documentation, and ensure compliance to all applicable laws, guidance, and regulations.
Essential Responsibilities:
- 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.
- Demonstrate proficiency 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, as general accuracy.
- Assist with root cause analysis to maintain high integrity data and processes to minimize discrepancies and gaps.
- Gain knowledge of current CMS regulations and announcements affecting risk adjustment. This includes review of regulatory announcements, attending educational sessions provided by regulatory entities, as well as staying apprised of educational opportunities within the industry.
- Assist in developing, maintaining, and reporting out on actionable metrics related to risk adjustment and incorporating quality/health outcome metrics where applicable.
- Work with changing data, file specifications, and internally coordinate releases and modifications through approved procedures.
- Collaborate with internal and external partners to resolve data issues related to member, claim, provider and pharmacy data and processes.
- Work with internal teams, provider partners, and vendor partners as needed to support risk adjustment activities.
Supporting Responsibilities:
- Meet department and company performance and attendance expectations.
- Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
- Perform other duties as assigned.
Work Experience:
One years’ experience in data analytics. Proficiency in Microsoft Excel and SAS/SQL is preferred. Equivalent work and education experience will be considered.
Education, Certificates, Licenses:
Bachelor's degree in Mathematics, Statistics, or similar research related field or equivalent work experience required.
Knowledge:
Excellent analytical and problem solving abilities are required. Some knowledge in basic theories and applications of computer programming preferred (SAS and VBA are the primary tools used). Ability to keep current with changing technologies, work independently under limited supervision, exercise initiative within established procedural guidelines, and prioritize work to meet established deadlines a must. Ability to communicate clearly and concisely, both orally and in writing when making presentations and creating documents. The ability to establish and maintain effective work relationships, exercise good judgement, and demonstrate decisiveness and creativity. Read, understand, and interpret documents of complex subject matter.
Competencies:
Adaptability
Building Customer Loyalty
Building Strategic Work Relationships
Building Trust
Continuous Improvement
Contributing to Team Success
Planning and Organizing
Work Standards
Environment:
Work inside in a general office setting with ergonomically configured equipment. Travel estimated to be 10% of the time.
Skills:
Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork
Our Values
We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:
- We are committed to doing the right thing.
- We are one team working toward a common goal.
- We are each responsible for customer service.
- We practice open communication at all levels of the company to foster individual, team and company growth.
- We actively participate in efforts to improve our many communities-internally and externally.
- We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
- We encourage creativity, innovation, and the pursuit of excellence.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
