Renown Health · 3 days ago
Risk Adjustment Analyst
Reno, NV
Full-time
Onsite
Entry, Mid Level
2+ years expRenown Health is a healthcare organization seeking a Risk Adjustment Analyst to support their Medicare Advantage and Commercial Risk Adjustment programs. The role involves data management, reporting analysis, and collaboration with various departments to enhance risk adjustment initiatives and ensure accurate risk score representation.
Health CareHospitalSocial MediaWellness
Responsibilities
Perform analysis and reporting activities relating to: risk score calculation, claims/encounters data submission, chart review programs, audits, and related performance metrics
Participate in the development of requirements, testing and refinement of the underlying data and systems
Collaborate with other business units to deliver reports/updates on underlying data and systems as used by the Risk Adjustment team
Analyze data flow and data integrity to identify areas for improvement
Understand and advise on CMS risk score methodology, including risk score calculation, hierarchical condition categories (HCCs), financial risk receivable calculations, RAPS and EDS processes and key regulator deadlines for data submission, RAPS and EDS Return Files and Error Files, ICD coding, claims, and provider data
Operate risk adjustment analytic vendor platforms to assist with intervention tracking, monitoring, analysis and reporting of diagnosis codes that drive risk score calculations
Work cross functionally across multiple departments to design and develop financial dashboards, KPIs, and models to identify and track profit/loss and ROI trends
Collaborate with Risk Adjustment Coders and Risk Adjustment Nurses to build internal projects based on diagnosis code, procedures, etc. trends for prospective and/or retrospective review
Contribute to developing materials and presenting key updates to Senior Leadership regarding risk adjustment programs and provider and member engagement initiatives
Qualification
Required
Must have working-level knowledge of the English language, including reading, writing, and speaking English
Bachelor's degree from an accredited institution required
Minimum of two years in an analyst role required, preferably in the healthcare industry
Advanced Excel skills required, that include working with large data sets, creating standardized reports, utilizing vLookups and advanced functions/ formulas; creating, using and interpreting pivot tables, filtering and formatting
Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel, and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc
Preferred
Preferred concentration in Business, Finance, Economics, Computer Science or Management Information Systems
Preferred work experience with SAS and/or SQL to create queries, pull large data sets and perform data manipulations/analysis
Preferred experience with ICD codes, medical claims, Medicare Advantage and Commercial/ACA products
Benefits
Eligible for Benefits
Company
Renown Health
Renown Health is northern Nevada's not-for-profit integrated health network.
5001-10000 employees
Funding
Current Stage
Late StageTotal Funding
unknownKey Investors
Baldrick's Foundation
2023-11-21Grant
Leadership Team
Brian Erling
President & Chief Executive Officer
Recent News
PR Newswire UK
2025-12-24
HealthCareIT News
2025-11-21
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