Curana Health · 2 months ago
Senior Analyst, Risk Adjustment
United States
Full-time
Remote
Senior Level
5+ years expCurana Health is a national leader in value-based care focused on improving the health and dignity of older adults. The Senior Risk Adjustment Analyst will collaborate with various partners to perform data analyses, develop reports, and ensure compliance with regulations, all aimed at enhancing risk adjustment processes and outcomes.
Hospital & Health Care
Responsibilities
Recommend and guide process improvements that will capture accurate risk adjustment factor increases while mitigating inaccurate capture of disease burden
Identify, analyze, interpret and communicate risk adjustment trends to provider partners and related entities through detailed/summary reports and presentations
Responsible for maintenance of existing reports and development of new reports to help ensure company goals are met, as well as other ad hoc requests as needed
Develop and maintain data sets leveraging internal data, response files from regulatory entities (MMR, MOR, RAPS response, EDPS, MAO-002, MAO-004, etc.), and ancillary data sources to be consumed across the enterprise
Understand the various risk models, risk score build-up, and Medicare Risk Adjustment calendar
Maintain strict oversight of vendors and plan partners through analytical reconciliations to ensure regulatory compliance, optimal data submissions and error resolution, and general accuracy
Assist with all pertinent audits, including RADV, through preparation activities and documentation
Perform root cause analyses to maintain high integrity data and processes to minimize discrepancies and gaps
Maintain a high level of familiarity 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 educational opportunities within the industry
Develop, maintain, and report out on actionable metrics related to risk adjustment and incorporate quality/health outcome metrics where applicable
Provide support as needed for projecting annual receivable amounts, preparing projections related to pricing efforts, and predicting cost utilization as it relates to risk adjustment
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, plan partners, and vendors as needed to support risk adjustment activities
Qualification
Required
Bachelor's Degree (BA/BS) required
5+ years of Risk Adjustment experience within the healthcare space or risk adjustment focused vendor
Experience working in a fast-paced environment with ability to work independently and drive key deliverables forward
Ability to dissect a problem, articulate a hypothesis with supporting data, and propose a recommendation
Ability to communicate complex ideas or processes in a simple, easily digestible manner to a range of audiences
Strong technical acumen and analytical skills required, including high proficiency in Excel and SQL
Strong verbal and written communication with proven experience developing executive-facing presentations or other deliverables
Comfortable with ambiguity and motivated to work collaboratively to solve complex problems
Preferred
Familiarity and experience with value-based care concepts and payment models (e.g., ACOs, Medicare Advantage)
AAPC or AHIMA coding certification is a plus
PTT and/or PowerBI experience preferred, but not required
Company
Curana Health
A national leader in value-based care, Curana Health is on a mission to improve the health, happiness, and dignity of older adults across the country.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Brian Arnds
Chief People Officer
Darryl Landahl
Chief Legal Officer
Recent News
2023-09-11
Business Journals
2023-05-16
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