PacificSource Health Plans

Risk Adjustment Analyst

US-OR-Eugene
Job ID
2017-256
Type
Regular Full-Time
Hiring Pay Range
49,500 - 58,000
# of Openings
1
Status
Exempt

Overview

Support enterprise risk adjustment programs for all applicable PacificSource lines of business. Working with leadership and operating units, responsible for analyzing, monitoring, and controlling the data and systems related to risk adjustment.

Responsibilities

 

  1. Assist with periodic reviews and validations of vendor applications/solutions for accuracy.
  2. Assist with root cause analysis to maintain high integrity data and processes to minimize discrepancies and gaps.
  3. Develop and run regular reporting pertaining to risk adjustment information and operations.
  4. Gain knowledge of current CMS regulations and announcements impacting risk adjustment.
  5. Assist with risk adjustment submissions to meet internal operational requirements and CMS regulatory guidelines.
  6. Work with changing data and file specifications and internally coordinate releases and modifications through approved procedures.
  7. Collaborate with internal and external partners to resolve data issues related to member, claim, provider and pharmacy data and processes.

Supporting Responsibilities:

  1. Meet department and company performance and attendance expectations.
  2. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
  3. Perform other duties as assigned.

Qualifications

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: Some knowledge in basic theories and applications of computer programming, SQL and SAS operating systems, and understanding of the risk adjustment model. Ability to analyze, identify, and resolve problems, keep current with changing technologies, work independently under limited supervision, exercise initiative within established procedural guidelines, and organize and prioritize work to meet established deadlines, communicate clearly and concisely, both orally and in writing when making presentations and creating documents such as user guides, establish and maintain effective work relationships, exercise good judgement, decisiveness and creativity, and prioritize work effectively. Read, understand, and interpret documents of complex software subject matter.

 

 

Competencies

  • Adaptability
  • Building Customer Loyalty
  • Building Strategic Work Relationships
  • Building Trust
  • Continuous Improvement
  • Contributing to Team Success
  • Planning and Organizing
  • Work Standards

Our Values

  • We are committed to doing the right thing.
  • We are one team working toward a common goal.
  • We are each responsible for our customers’ experience.
  • 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 communities-internal and external.
  • We encourage creativity, innovation, continuous improvement, and the pursuit of excellence.

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is estimated to be 10% of the time.

 

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.

 

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.

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