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Risk Adjustment Analyst

HealthCare Partners Garden City Full-Time
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HealthCare Partners, IPA and HealthCare Partners, MSO together comprise our health care delivery system providing enhanced quality care to our members, providers and health plan partners. Active since 1996, HealthCare Partners (HCP) is the largest physician-owned and led IPA in the Northeast, serving the five boroughs and Long Island. Our network includes over 6,000 primary care physicians and specialists delivering services to our 125,000 members enrolled in Commercial, Medicare and Medicaid products. Our MSO employs 240+ skilled professionals dedicated to ensuring members have access to the highest quality of care while efficiently utilizing healthcare resources.

HCP’s vision is to be recognized by members, providers and payers as the organization that delivers unsurpassed excellence in healthcare to the people of New York and their communities.
We pride ourselves on selecting the most qualified candidates who reflect HCP’s mission of serving our members by facilitating the delivery of quality care.
Interested in joining our successful Garden City Team?  We are currently seeking an  Risk Adjustment Analyst for our Garden City Office! 

JOB SUMMARY: An Assistant Risk Adjustment Analyst supports revenue program management activities around the end-to-end process of data management and submissions to HCP’s payer partners. Also serve as an analyst/technical specialist for HCP’s risk adjustment program. Along with providing analytic support to risk adjustment revenue functions by assisting with developing and implementing systems, processes, and standards to ensure risk scores accurately reflect HCP’s membership health profile.
The position will support revenue program management activities around data management and submissions to CMS. Serve as a advisor to management and stakeholders around end-to-end process of data management, data processing, data analysis and submissions. Supporting the interface with different business areas on the execution of data submissions, identifying and applying best practices and processes to ensure efficiency and accuracy of end-to-end operation of risk adjustment programs. Assist with recommendations of both strategic and tactical improvements, and contribute to compliance to all applicable laws, guidance, and regulations. Assist the senior risk adjustment analyst in developing and sustaining a long-term optimal structure and processes around emerging encounter data submission requirements; analyzing, monitoring, and planning key risk adjustment milestones and identifying and recommending opportunities for improvement.

  • Support program activities around data submission and management to ensure maximum efficiencies, accuracy and completeness. Contribute to defining strategic and tactical approaches to improve risk adjustment operations across the enterprise to support the underlying workflow of these systems.
  • Participate in the development of requirements, testing and refinement of the underlying data and systems. Collaborate with other business units to deliver requirements around necessary updates to underlying data and systems as used by the Risk Adjustment and Coding departments.
  • Monitor and asses processes around data collection, submission, and reconciliation to ensure full compliance with all applicable laws, guidance, and regulations. Contribute to detailed reporting and oversight for data submission activities, minimizing variance between RAPS and EDPS data sets. Assist in developing dashboards to report progress with sponsors and escalate issues with key stakeholders.
  • Understand and advise on CMS risk score methodology, including risk score calculation, financial risk receivable calculations, RAPS and EDS processes and key regulator deadlines for data submission, RAPS and EDS Return Files and Error Files, understand eligibility, ICD coding, claims, and provider data.
  • Assist the senior risk adjustment analyst with monitoring and reconciling submitted encounters against response files to ensure that submission gaps are addressed in a timely manner. Support the interface with Quality, Finance, IT, Provider, Claims, Business Intelligence, and other HCP teams to improve and correct data.
  • Analyze data flow and data integrity to identify areas for improvement in risk adjusted revenue.
  • Monitor routine quality assurance checks to ensure data accuracy and completeness and execute corrections as needed.
  • Update and maintain business process and technical workflow documents.
  • Operate risk adjustment analytic vendor platforms to assist with intervention tracking, monitoring, analysis and reporting of diagnosis codes that drive risk adjusted payments.
  • Analyze and interpret provider-specific results and risk score trend information; develop dashboard reporting and a regular schedule for delivering the results of analyses to improve awareness and understanding of risk adjustment results and the quality, accuracy and identification of member health conditions.
    Assist the senior risk adjustment analyst in providing HCP Teams with appropriate tools, resources, and reports to help achieve success with downstream providers.
  • Analyze and advise on a comprehensive understanding of a provider’s risk score trends, EMR systems, contracting arrangements, and business models to recommend generate provider-specific engagement plans.
  • Support project management efforts including monitoring and evaluating progress against timelines, project milestones, key deliverables, and resource requirements. Track and monitor mechanisms for all Risk Adjustment and Coding programs. Support the Risk Adjustment senior analyst in ensuring that key risk adjustment performance metrics and business objectives are defined and achieved.
  • Collaborate across business units to coordinate the development of financial dashboards and models to identify and track revenue and ROI trends. Work with team members to understand and monitor the financial impact of risk adjustment programs.
  • Contribute to developing materials and presenting key updates to HCP leadership regarding risk adjustment programs and provider and member engagement initiatives.

Skills, Knowledge, Abilities: 
  • Intermediate proficiency in SQL (required).
  • Intermediate proficiency in MS Excel (required).
  • Direct experience with and aptitude for using data warehouse/data mart products (recommended).
  • Direct experience with relational databases and knowledge of query tools (recommended).
  • Ability to manage projects and project plans within stated time line (required).
  • Ability to communicate effectively, and work well in a team oriented environment (required).
  • Resourceful and creative in solving complex issues and working corroboratively with others (required).
  • General knowledge of ICD-9/10 codes (required).

  • Bachelor or Associate degree in health related field (required).

  • A minimum of 3 years’ experience in managed care or other healthcare environment in an analyst role.
  • Direct experience with CMS HCC risk adjustment methodology and risk revenue financial analytics (required).
  • Direct experience with RAPS/encounter data submission processes (required).
  • Direct experience utilizing risk adjustment analytic vendor platforms (required).
  • Direct experience with CRG risk adjustment methodology (preferred).

HealthCare Partners, MSO provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, HealthCare Partners, MSO complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.


Skills required

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Job ID: IP245


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