Risk Adjustment Program Analyst at Capital Blue Cross

Harrisburg, Pennsylvania, United States -

Full Time

Start Date

Immediate

Expiry Date

19 Jan, 26

Salary

0.0

Posted On

21 Oct, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Analytical Skills, Planning, Problem Solving, Verbal Communication, Written Communication, Data Reporting, Medicare Data Reporting, Claims Data Reporting, Enrollment Data Reporting, ICD-10 Coding, Root Cause Analysis, Project Management, Research Principles, Automation, Team Collaboration, Performance Monitoring

Industry

Insurance

Description

Position Description Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more. At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.” The Risk Adjustment Program Analyst is responsible for supporting the planning, organizing, directing, and implementation of department strategy related to Medicare Risk Adjustment. This role involves analyzing clinical, claims, and enrollment data to ensure compliance with government regulations, identifying trends, and collaborating with cross-functional teams to support the strategic objectives of the department. This position operates within broad objectives to ensure optimum utilization of manpower and budget. Responsibilities and Qualifications Provide analytical support on operational and performance deliverables prospective and retrospective initiatives, trends and identify areas for improvement. Uses a combination of, analysis, reporting, to support leadership, performance reporting/monitoring, and strategic development. Builds and supports business reports to be included in executive dashboard. Supports research, analysis, identification, and evaluation of operational data from assigned problems to evaluate existing and potential trends and issues. Possesses and maintains knowledge of Capital business, products, programs (including provider data, networks, etc.), corporate organizational structure (including functional responsibilities), and basic research principles and methodologies. Simultaneously supports and monitors performance of multiple projects by maintaining project plans and objectives to ensure strategic alignment within defined parameters. Develops lines of communication to discuss and review results of analysis to management via reports and presentations and assists management in implementing programs that provide solutions. Investigates, reviews, recommends, communicates, and implements solutions based on root cause analysis. Identifies and resolves challenges in order to fulfill key corporate objectives and responds to the demands of change management and initiates actions needed to plan, organize, and control team activities. Independently develops and plans reports, papers, and/or other materials in a clear and concise manner. Supports ongoing maintenance of executive dashboard and related products, applications, and platforms, continuously striving towards automation. Works with analytics business analysts/developers and operations personnel to automate dashboard functions. Completes ad hoc data and analytic requests as assigned. Skills: Excellent analytical, planning, problem solving, verbal, and written skills to communicate complex ideas. Excellent knowledge and use of existing software packages (PowerPoint, Excel, Word, etc.) CMS reporting, Medicare data reporting, claims data reporting, and enrollment data reporting preferred. Ability to work independently, within a team environment, and communicate effectively with employees at all levels. Knowledge: Knowledge of CMS Medicare HCC risk adjustment models and methodologies, ICD-10 coding, and interacting with large amounts of healthcare data. Experience: 3 years' experience in risk adjustment. Education and Certifications: High School diploma or equivalent. Bachelor's degree preferred. About Us We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.

Responsibilities

The Risk Adjustment Program Analyst supports the planning and implementation of department strategy related to Medicare Risk Adjustment. This role involves analyzing clinical, claims, and enrollment data to ensure compliance with regulations and collaborating with cross-functional teams.