Blue Cross and Blue Shield of Kansas
Risk Adjustment Analyst
Blue Cross and Blue Shield of Kansas, Topeka, Kansas, United States, 66604
Risk Adjustment Analyst
The Risk Adjustment Analyst is responsible for reporting accurate and timely Medicare Advantage (MA) risk adjustment data to leadership and Centers for Medicare & Medicaid Services (CMS), executing and monitoring risk adjustment improvement initiatives in coordination with multiple corporate divisions and vendors, and developing estimates of risk adjustment payments. Position works jointly with Underwriting, Actuarial Research, Accounting, Provider Relations, Medical Affairs, Compliance, and Information Technology & Services to generate meaningful reports, produce financial estimates, and identify and act on risk adjustment opportunities. This position is eligible to work hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment. Why Join Us? Family Comes First: Total rewards package that promotes the idea of family first for all employees. Professional Growth Opportunities: Advance your career with ongoing training and development programs. Dynamic Work Environment: Collaborate with a team of passionate and driven individuals. Stability: 80 years of commitment, compassion and community Flexibility: Options to work onsite, hybrid or remote available Compensation $83,280 - $99,000 Exempt Grade 16 Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts. What You'll Do Develop and maintain subject matter expert knowledge of the CMS ACA/MA risk adjustment program requirements, methodologies, and improvement initiatives. Review CMS communications pertaining to ACA/MA risk adjustment. Propose policy and procedure changes to comply with any new CMS requirements Facilitate accurate and timely ACA/MA risk adjustment reporting to CMS, to maintain compliance with internal and federal requirements and optimize revenue. Maintain reporting and modeling tools to achieve that end and identify and develop tool improvements. Analyzes and research RAPS/EDPS files, RAPS return files, and EDPS return files to reconcile RAPS/EDPS submissions against CMS technical specifications. Collaborates with external vendors and internal staff to resolve any errors. Conduct proactive outreach to healthcare providers and members to identify and close health gaps, improving health outcomes and quality metrics. Assist with the development of provider education materials related to ACA/MA risk adjustment. Assist with the development of ACA/MA risk adjustment improvement initiatives & incentive programs. Support the identification, gathering, organizing, and analyzing of data sources, both internal and external, that improve our knowledge of enrollees and opportunities for enhanced risk adjustment. Propose alternative data sources and process improvements where possible. Analyze and report trends in ACA/MA risk adjustment data throughout each calendar year. Maintain the analysis and reporting models as needed and identify and develop model improvements. Designs, develops and validates reports and dashboards to measure ACA/MA risk adjustment performance. Prepare ad-hoc reports as needed What You Need Bachelor's Degree in Mathematics, Statistics, Health Care or Business Administration, Finance, or related field is required. Two years of related experience is required. Knowledge/Skills/Abilities Must possess advanced analytical, problem solving, and research skills. Must have the ability to see and anticipate significant issues or trends affecting risk adjustment. Ability to accurately interpret CMS guidelines for the purpose of refining and implementing procedures that maintain high standards for the timely and accurate reporting of actionable information to relevant stakeholders. Maintain current knowledge, skill and abilities in risk adjustment theories, practices and technologies. Skilled with Microsoft Word, Excel, and Access. Ability to work with computer programming and PC data analysis tools such as SQL. Ability to understand the capabilities, limitations, and characteristics of the corporate data systems. Must effectively use interpersonal and communications skills with tact and diplomacy. This position maintains interaction with vendors and employees throughout the company. Must have experience working on multiple ongoing projects and exhibit the capability to lead projects. The ability to work well independently or with other employees, management, and vendor staff is expected. Bonus if You Have Experience with and knowledge of compliance, information systems, and other health insurance administration concepts and principles is highly preferred. Experience with and an understanding of data warehouse, data extraction tools, and analytics software and methods is highly preferred. Understanding of CMS Risk Adjustment Processing System (RAPS), Encounter Data Processing System (EDPS), and MA Stars reporting requirements and the risk adjustment and MA Stars models and factors is highly preferred. Benefits & Perks Base compensation is only one component of your competitive Total Rewards package
Incentive pay program (EPIP) Health/Vision/Dental insurance 6 weeks paid parental leave for new mothers and fathers Fertility/Adoption assistance 2 weeks paid caregiver leave 5% 401(k) plan matching Tuition reimbursement Health & fitness benefits, discounts and resources
Our Commitment to Connection and Belonging At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law. Blue Cross and Blue Shield of Kansas conducts pre-employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment.
The Risk Adjustment Analyst is responsible for reporting accurate and timely Medicare Advantage (MA) risk adjustment data to leadership and Centers for Medicare & Medicaid Services (CMS), executing and monitoring risk adjustment improvement initiatives in coordination with multiple corporate divisions and vendors, and developing estimates of risk adjustment payments. Position works jointly with Underwriting, Actuarial Research, Accounting, Provider Relations, Medical Affairs, Compliance, and Information Technology & Services to generate meaningful reports, produce financial estimates, and identify and act on risk adjustment opportunities. This position is eligible to work hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment. Why Join Us? Family Comes First: Total rewards package that promotes the idea of family first for all employees. Professional Growth Opportunities: Advance your career with ongoing training and development programs. Dynamic Work Environment: Collaborate with a team of passionate and driven individuals. Stability: 80 years of commitment, compassion and community Flexibility: Options to work onsite, hybrid or remote available Compensation $83,280 - $99,000 Exempt Grade 16 Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts. What You'll Do Develop and maintain subject matter expert knowledge of the CMS ACA/MA risk adjustment program requirements, methodologies, and improvement initiatives. Review CMS communications pertaining to ACA/MA risk adjustment. Propose policy and procedure changes to comply with any new CMS requirements Facilitate accurate and timely ACA/MA risk adjustment reporting to CMS, to maintain compliance with internal and federal requirements and optimize revenue. Maintain reporting and modeling tools to achieve that end and identify and develop tool improvements. Analyzes and research RAPS/EDPS files, RAPS return files, and EDPS return files to reconcile RAPS/EDPS submissions against CMS technical specifications. Collaborates with external vendors and internal staff to resolve any errors. Conduct proactive outreach to healthcare providers and members to identify and close health gaps, improving health outcomes and quality metrics. Assist with the development of provider education materials related to ACA/MA risk adjustment. Assist with the development of ACA/MA risk adjustment improvement initiatives & incentive programs. Support the identification, gathering, organizing, and analyzing of data sources, both internal and external, that improve our knowledge of enrollees and opportunities for enhanced risk adjustment. Propose alternative data sources and process improvements where possible. Analyze and report trends in ACA/MA risk adjustment data throughout each calendar year. Maintain the analysis and reporting models as needed and identify and develop model improvements. Designs, develops and validates reports and dashboards to measure ACA/MA risk adjustment performance. Prepare ad-hoc reports as needed What You Need Bachelor's Degree in Mathematics, Statistics, Health Care or Business Administration, Finance, or related field is required. Two years of related experience is required. Knowledge/Skills/Abilities Must possess advanced analytical, problem solving, and research skills. Must have the ability to see and anticipate significant issues or trends affecting risk adjustment. Ability to accurately interpret CMS guidelines for the purpose of refining and implementing procedures that maintain high standards for the timely and accurate reporting of actionable information to relevant stakeholders. Maintain current knowledge, skill and abilities in risk adjustment theories, practices and technologies. Skilled with Microsoft Word, Excel, and Access. Ability to work with computer programming and PC data analysis tools such as SQL. Ability to understand the capabilities, limitations, and characteristics of the corporate data systems. Must effectively use interpersonal and communications skills with tact and diplomacy. This position maintains interaction with vendors and employees throughout the company. Must have experience working on multiple ongoing projects and exhibit the capability to lead projects. The ability to work well independently or with other employees, management, and vendor staff is expected. Bonus if You Have Experience with and knowledge of compliance, information systems, and other health insurance administration concepts and principles is highly preferred. Experience with and an understanding of data warehouse, data extraction tools, and analytics software and methods is highly preferred. Understanding of CMS Risk Adjustment Processing System (RAPS), Encounter Data Processing System (EDPS), and MA Stars reporting requirements and the risk adjustment and MA Stars models and factors is highly preferred. Benefits & Perks Base compensation is only one component of your competitive Total Rewards package
Incentive pay program (EPIP) Health/Vision/Dental insurance 6 weeks paid parental leave for new mothers and fathers Fertility/Adoption assistance 2 weeks paid caregiver leave 5% 401(k) plan matching Tuition reimbursement Health & fitness benefits, discounts and resources
Our Commitment to Connection and Belonging At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law. Blue Cross and Blue Shield of Kansas conducts pre-employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment.