Jobs
>
Seattle

    Risk Adjustment Analyst II - Seattle, United States - Community Health Plan of Washington

    Community Health Plan of Washington
    Community Health Plan of Washington Seattle, United States

    2 weeks ago

    Default job background
    Description

    Job Description

    Job Description

    Who we are

    Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.

    Our commitment is to:

    • Strive to apply an equity lens to all our work.
    • Reduce health disparities.
    • Become an anti-racist organization.
    • Create an equitable work environment.

    About the Role

    Support CHPW's risk adjustment activities, advancing the effectiveness and value of population health and risk adjustment initiatives through targeted analytics. This role is integral in driving improved health outcomes and reducing overall healthcare costs.

    To be successful in this role, you:

    • Bachelor's degree in quantitative discipline such as Mathematics, Statistics, Actuarial Science or Economics, or related field, or an equivalent combination of education and highly relevant experience
    • Have a minimum of three (3) years' experience analyzing healthcare claims/encounter data
    • Have Experience in Commercial, Medicare and/or Medicaid Risk Adjustment models
    • Proven analytical and quantitative skills, including experience with managing and modeling of large data sets
    • Have applied understanding of risk adjustment model(s)

    Essential functions and Roles and Responsibilities:

    • Design, develop, and implement in depth analyses, reporting, dashboards, and trend analysis to support internal and external business customers.
    • Supports or leads projects/initiatives that span departments and hold accountability for providing analytic support.
    • Conducts routine and complex quantitative analyses and data validation using tools such as SQL, SAS, Excel, Tableau or other analytical software.
    • Works with stakeholders and team to understand business questions and problems and to scope data analysis and reporting requests.
    • Manages the analytic component of complex departmental projects, including audits.
    • Maintains compliance with CMS requirements, modeling financial impacts to changes in risk adjustment data and methodologies.
    • Effectively tracks and monitors performance of retrospective and prospective risk adjustment programs, identifying issues and making recommendations.
    • Supports encounter data reporting processes for EDPS, RAPS and the EDGE server, including tracking, reporting, and resolving rejections. Conducts gap analysis and data validation, identifying possible issues in data submission and determining financial impact.
    • Works directly with IS&T, Operations, and external vendors to ensure submission of accurate and complete risk adjustment data.
    • Provides decision support for department, including data requests for financial statement accruals, bids, and budget.
    • Analyze, reconcile, and evaluate/interpret complex data from various sources, maintaining data consistency and integrity. Proposes and implements innovative approaches to creating or improving automation, optimizing department processes where appropriate.
    • Maintain ongoing quality control of delivered reports through self-review and peer review, ensuring reports have a high degree of credibility with all users.
    • Complete ad hoc analyses to support internal and external customers.
    • Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.

    Knowledge, Skills, and Abilities:

    • Ability to analyze, organize, and prioritize work while meeting multiple deadlines.
    • Skilled at collecting and analyzing complex data.
    • Skilled in using logic and reasoning to identify strategies and weaknesses or alternative solutions, conclusions, or approaches to problems.
    • Knowledgeable of data management methods.
    • Highly skilled in using Microsoft Office, such as Outlook, Teams, Word, and Outlook.

    As part of our hiring process, the following criteria must be met:

    • Complete and successfully pass a criminal background check.

    Criminal History: includes review of criminal convictions and probation. CHPW does not automatically or categorically exclude persons with a criminal background from employment. The applicant's criminal history will be reviewed on a case-by-case basis considering the risk to the business, members, and/employees.

    • Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.
    • Vaccination requirement (CHPW offers a process for medical or religious exemptions)
    • Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.

    Compensation and Benefits:

    The position is FLSA Exempt and is not eligible for overtime. Based on market data, this position grade is 68E (see full range below) and has a 10% annual incentive target based on company, department, and individual performance goals.

    CHPW offers the following benefits for Full and Part-time employees and their dependents:

    • Medical, Prescription, Dental, and Vision
    • Telehealth app
    • Flexible Spending Accounts, Health Savings Accounts
    • Basic Life AD&D, Short and Long-Term Disability
    • Voluntary Life, Critical Care, and Long-Term Care Insurance
    • 401(k) Retirement and generous employer match
    • Employee Assistance Program and Mental Fitness app
    • Financial Coaching, Identity Theft Protection
    • Time off including PTO accrual starting at 17 days per year.
    • 40 hours Community Service volunteer time
    • 10 standard holidays, 2 floating holidays
    • Compassion time off, jury duty

    Sensory/Physical/Mental Requirements:

    Sensory*:

    • Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.

    Physical*:

    • Extended periods of sitting, computer use, talking and possibly standing
    • Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion
    • Frequent torso/back static position; occasional stooping, bending, and twisting.
    • Some kneeling, pushing, pulling, lifting, and carrying (not over 25 pounds), twisting, and reaching.

    Mental:

    • Must be able to manage conflict, communicate effectively and meet time-sensitive deadlines.

    Work Environment:

    Office environment Employees who frequently work in front of computer monitors are at risk for environmental exposure to low-grade radiation.

  • Community Health Plan of Washington

    Risk Adjustment Analyst

    3 weeks ago

    Community Health Plan of Washington Seattle, United States

    ** Risk Adjustment Analyst** · **Job Category****:** Accounting & Finance **Requisition Number****:** RISKA001587 Showing 1 location **Job Details** · **Description** · **Job Summary****:** · At CHPW, analytics translate healthcare data into actionable insights. This role lea ...

  • Community Health Plan of Washington

    Risk Adjustment Analyst

    1 week ago

    Community Health Plan of Washington Seattle, United States

    ** Risk Adjustment Analyst** · **Job Category****:** Accounting & Finance · **Requisition Number****:** RISKA001587 · Showing 1 location · **Job Details** · **Description** · **Job Summary****:** · At CHPW, analytics translate healthcare data into actionable insights. This rol ...

  • Community Health Plan of Washington

    Business Analyst, Risk Adjustment

    1 week ago

    Community Health Plan of Washington Seattle, United States

    ** Business Analyst, Risk Adjustment** · **Job Category****:** Accounting & Finance · **Requisition Number****:** BUSIN001595 · Showing 1 location · **Job Details** · **Description** · **Job Summary** · The Business Analyst, Risk Adjustment has expertise in all aspects of risk ...

  • CHPW

    Risk Adjustment Analyst II

    3 weeks ago

    CHPW Seattle, United States

    Who we are · Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawf ...

  • PacificSource Administrators, Inc.

    Risk Adjustment Analyst

    3 weeks ago

    PacificSource Administrators, Inc. Tacoma, United States

    **Position Overview:** The 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 kno ...

  • PacificSource Administrators, Inc.

    Senior Risk Adjustment Analyst

    1 week ago

    PacificSource Administrators, Inc. Tacoma, United States

    **Position Overview:** 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 ...

  • PacificSource Administrators, Inc.

    Senior Risk Adjustment Analyst

    3 weeks ago

    PacificSource Administrators, Inc. Tacoma, United States

    **Position Overview:** 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 ...

  • Ziply Fiber

    Business Intelligence Analyst

    1 week ago

    Ziply Fiber Kirkland, United States

    Position Title: Business Intelligence Analyst · $63,750 to $106,250 annually DOE · Comprehensive health benefits include - medical, dental, vision, 401k, flexible spending account, paid · sick leave and paid time off, parental leave, quarterly performance bonus, training, career ...

  • Serco North America

    Lhd/lha Class Manager Support

    2 weeks ago

    Serco North America Washington Navy Yard, United States

    Position Description: · If you love high profile and challenging projects supporting the US Navy and its commercial partners - Serco has a great opportunity for you You will be a part of a team that collaborates closely with our customer and other Serco teams to deliver quality s ...

  • Serco North America

    Lhd/lha Ship Manager Support

    3 weeks ago

    Serco North America Washington Navy Yard, United States

    Position Description: · If you love high profile and challenging projects supporting the US Navy and its commercial partners - Serco has a great opportunity for you You will be a part of a team that works closely with our customer and other Serco teams to deliver quality support ...

  • General Motors Financial Company, Inc.

    Sr Credit Analyst II

    1 week ago

    General Motors Financial Company, Inc. Seattle, United States

    Your role would be to analyze consumer credit applications and leverage higher authority levels to make appropriate risk and profit adjusted decisions to drive excellent results. Relationships deliver results at GM Financial. Can you develop and stre Credit Analyst, Analyst, Tech ...

  • Jones Lange Lasalle, Inc.

    Sr. Financial Analyst

    2 weeks ago

    Jones Lange Lasalle, Inc. Seattle, United States

    Initiate annual planning process and respond to ad hoc Purchase Order (PO) requests under supervision of Client Program Manager. Analyze the budget and adjust funding levels accordingly for new purchase requests. Monitor all POs and provide ongoing Financial Analyst, Program Mana ...

  • Amazon

    Sales Compensation Manager, SMGS Ops

    1 week ago

    Amazon Seattle, United States

    Job ID: | Amazon Web Services, Inc. · The Amazon Web Services (AWS) Global Sales Compensation (GSC) team is seeking a Sales Compensation Manager to join our Operations team. As a manager in the Global Sales Compensation Operations organization, you will be responsible for managin ...

  • Expedia Group

    Senior Global Stock

    2 weeks ago

    Expedia Group Seattle, United States

    Job Description · If you need assistance during the recruiting process due to a disability, please reach out to our Recruiting Accommodations Team through the Accommodation Request form. This form is used only by individuals with disabilities who require assistance or adjustments ...

  • F5 Networks

    Senior Data Analyst

    3 weeks ago

    F5 Networks Seattle, United States

    At F5, we strive to bring a better digital world to life. Our teams empower organizations across the globe to create, secure, and run applications that enhance how we experience our evolving digital world. We are passionate about cybersecurity, from protecting consumers from frau ...

  • All Medical Personnel

    rn - telemetry

    3 weeks ago

    All Medical Personnel Seattle, WA , USA, United States

    Specialty: RN-Telemetry - Travel · Job Description · Assist physicians with patient management · Identifies irregular telemetry readings and notify appropriate medical team members · Monitor and adjust specialized equipment used on patients, and interpret and record electronic ...

  • Next Step Systems

    Investment Trust Fund Manager, Mandarin Language Required

    2 weeks ago

    Next Step Systems Seattle, United States

    Investment Trust Fund Manager, Mandarin Language Required, Seattle, WA · We are seeking an Investment Trust Fund Manager for a great opportunity in Seattle, WA. This position is 100% Onsite and not Remote. · Investment Trust Fund Manager Responsibilities: · Research and apply for ...

  • DevSelect

    Project Manager

    3 weeks ago

    DevSelect Seattle, United States

    A successful Project Manager will be able to create the structure and approach that will facilitate the collection, clear communication, and ultimate delivery of project goals and objectives. · Projects that this level of PM will work on have scopes that are relatively well defin ...

  • All Medical Personnel

    rn - telemetry

    3 weeks ago

    All Medical Personnel Seattle, WA, USA, United States

    Specialty: RN-Telemetry - Travel · Job Description · Assist physicians with patient management · Identifies irregular telemetry readings and notify appropriate medical team members · Monitor and adjust specialized equipment used on patients, and interpret and record electronic ...

  • Cigna

    Provider Performance Enablement Lead Analyst- Hybrid- Seattle, WA- Healthcare

    6 days ago

    Cigna Seattle, United States

    Job Description · Role Summary: · The Provider Performance Lead Analyst is a key member of the market that assists in the growth and development of the provider network. The Lead Analyst is the primary conduit to the providers and the individual that represents Cigna MA. · The Pr ...