Risk Adjustment Program Analyst

**MUST BE WILLING TO PHYSICALLY WORK NEAR SUNRISE, FLORIDA, 33323**

Position Summary: The Risk Adjustment Program Analyst will lead the overall risk adjustment program at Community Care Plan. In this role, you will be a key strategic leader developing and executing a multi-product risk adjustment strategy aimed at ensuring accurate diagnosis risk coding for CCP's Medicaid and CHIP populations and achieving related revenue targets.Joining Community Care plan means joining a provider sponsored health plan leader with a diverse and complex landscape of risk adjustment activities.The Risk Adjustment ProgramAnalyst will be responsible for building out core health plan-based risk adjustment operations, as well as developing innovative provider-based programs, and other product-specific risk adjustment strategies.Success will require competence in risk adjustment strategy, an ability to build and scale risk adjustment programs, and an ability to partner effectively with provider groups to design and implement point of care risk adjustment interventions.

Qualifications:

Experience Required:

• Bachelor's degree in Business or Healthcare Administration or related field required; Advanced degree preferred

Preferred/Desirable:

• Proven ability to align cross-functional teams and drive action to meet internal and external business and program goals and objectives. Advanced statistical analysis and Microsoft office
• Comprehensive knowledge of health plan activities with emphasis on Medicare or Medicaid Risk Adjustment programs
• Knowledge of regulatory risk adjustment requirements and processes and audit requirements

Essential Duties and Responsibilities:

1. Engaging stakeholders to define a system strategy for risk adjustment, including strategies for provider engagement, IT system capabilities. Strategy, planning, and end-to-end oversight to ensure accurate and complete risk adjustment.
2. Develop and implement Standard Operational Procedures, workflows, and process documentation policies for risk adjustment programs.
3. Monitor risk adjustment submissions as compared to expected revenue and proactively address gaps in data submissions and impacts to forecasting and budgets.
4. Accountable for ensuring ongoing key performance indicators measure productivity, quality, and overall impact of the company's risk adjustment program, including reporting KPI results on a monthly basis. Maintains risk adjustment performance management and reporting dashboard
5. Direct the development of key analytics and data to support Risk Adjustment financial forecasts, analysis and reporting to engage key stakeholders and communicate program results to the organization.
6. Partner with Clinical and Financial Analytics teams to define opportunities and areas of focus to optimize risk adjustment performance across all products.
7. Develop member and provider engagement strategies, including the use of value-based payments, incentives, and other levers to encourage proactive risk management.
8. Expert on risk adjustment models; maintains current view of risk adjustment regulatory changes and product-specific risk model changes; ensures appropriate operational responses to regulatory and risk adjustment program changes.
9. Maximize return on investment in Risk Adjustment operations by reducing reliance on vendors and increasing validity of data submissions.
10. Maintain and oversee an effective Risk Adjustment submission process.
11. Serve as point person for relationships with health plan partners, including contracting and revenue management elements of risk arrangements as well as partner oversight of ongoing performance.
12. Provider site engagement and partnerships:Partner with provider account teams to communicate risk adjustment strategies and initiatives to provider groups; partner with provider groups to implement risk adjustment initiatives.
13. Internal stakeholder management:Ensures open communication and collaboration across all relevant internal departments/positions that intersect with risk adjustment team (Quality, Provider Relations, Product teams, etc.)
14. Specific tasks may include design and implementation of the following: Retrospective coding program; Provider education campaigns; Provider incentive programs; Audit and compliance programs; EMR optimization / other IT strategies.

This job description in no way states or implies that these are the only duties performed by the employee occupying this position. Employees will be required to perform any other job-related duties assigned by their supervisor or management.

Skills and Abilities:

• Effective collaborative and proven process improvement skills
• Strong oral and written communication skills; ability to interact within all levels of the organization
• Demonstrated ability to successfully plan, organize and manage projects, critical thinking, problem-solving, and the analysis, interpretation, and evaluation of complex information
• Ability to conceptualize, create partnerships and facilitate change

WORK SCHEDULE:

As a continued effort to provide a safe and productive work environment, Community Care Plan is currently following a hybrid work schedule. Staff are able to work from home 3 days a week and will report to the office 2 days a week. *****The company reserves the right to change the work schedules based on the company needs.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, use hands, reach with hands and arms, and talk or hear. The employee is frequently required to stand, walk, and sit. The employee is occasionally required to stoop, kneel, crouch or crawl. The employee must occasionally lift and/or move up to 15 pounds.

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. The environment includes work inside/outside the office, travel to other offices, as well as domestic, travel. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

We are an equal opportunity employer who recruits, employs, trains, compensates and promotes regardless of age, color, disability, ethnicity, family or marital status, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our employees unique. We are committed to fostering, cultivating and preserving a culture of diversity, equity and inclusion.