Risk Adjustment Strategic Analyst

Blue Cross and Blue Shield of Kansas is looking to add to our Risk Adjustment team and has a new opportunity for a Risk Adjustment Strategic Analyst. This position is a cross-functional role designed to support high-priority initiatives and provide strategic insights across all areas of Risk Adjustment. Reporting directly to the Director of Risk Adjustment, this position operates outside of traditional team silos to support business continuity, lead special projects, and respond to executive-level data and analysis requests. The analyst will serve as a bridge across teams, using advanced analytics and broad program knowledge to identify opportunities, mitigate risks, and drive strategic improvements in both Commercial (ACA) and Medicare Advantage programs.

“This position is eligible to work hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.”

Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.

Why Join Us?

• Family Comes First: Total rewards package that promotes the idea of family first for all employees.
• Professional Growth Opportunities: Advance your career with ongoing training and development programs.
• Dynamic Work Environment: Collaborate with a team of passionate and driven individuals.
• Trust: Work for one of the most trusted companies in Kansas
• Balance: paid vacation and sick leave with paid maternity and paternity available immediately upon hire

Compensation

$83,280 - $99,000

Exempt Grade 16

• Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid.  All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.

What you’ll do

• Coordinate and deliver training based on risk adjustment results for healthcare providers. Develop and maintain subject matter expert knowledge of the CMS ACA/MA risk adjustment program requirements and methodologies
• Assist developing and maintain strategies to improve risk score accuracy for ACA and MA
• Designs, develops and validates executive level reports and dashboards to measure ACA/MA risk adjustment performance
• Review, and coordinate action from, CMS communications pertaining to ACA/MA risk adjustment. Recommend policy and procedure changes to comply with any new CMS requirements
• Create, analyze and report trends in ACA/MA risk adjustment data throughout each calendar year. Maintain the analysis and reporting models as needed and identify and develop model improvements
• Research and develop advanced data analysis from various sources (claims, encounters, membership, etc.)
• Analyzes and researches RAPS/EDPS files, RAPS return files, and EDPS return files to reconcile RAPS/EDPS submissions against CMS technical specifications. Collaborates with external vendors and internal staff to resolve any errors
• Make brief weekly reports to leadership, to include status updates of ACA/MA risk adjustment activities
• Develop, manage and/or assist with the development of ACA/MA risk adjustment improvement initiatives & incentive programs
• Assist with data analysis for the annual MA Health Effectiveness Data and Information Set (HEDIS) and other ACA/MA Stars reporting needs
• Assist with internal activities like chart retrieval, coding audits, and in-home assessments.
• Create and communicate strategic solutions that are clear, defensible, and actionable across internal and external stakeholders.
• Ongoing evaluation of industry best practices for risk adjustment and recommend changes to ensure corporate goals and objectives are being met
• Work with product, operations, and IT teams to enhance risk adjustment tools and infrastructure
• Prepare ad-hoc reports as needed

What you need

• Bachelor's degree in computer science, data analytics, mathematics, statistics, finance, or a related field required;

In lieu of a degree, a minimum of 7+ years of progressively responsible experience in risk adjustment, healthcare analytics, or a related field is required.

• 2 Years of related experience is required.

Knowledge/Skills/Abilities

• Proficiency using data analysis tools and technology such as SQL, Python, R, Excel, Power BI, and Tableau
• Demonstrates statistical and predictive data modeling of risk scores, coding results, member suspecting and predictive analytics
• Understanding of hierarchical condition category (HCC) suspecting tools
• Ability to see and anticipate significant issues or trends affecting risk adjustment
• Maintain knowledge, skill and abilities in risk adjustment theories, practices and technologies
• Must have experience working with healthcare coding and clinical terminology (ICD-10, CPT, HCPCS, etc.)
• Must have experience working on multiple ongoing projects and exhibit the capability to lead projects
• Must effectively use interpersonal and communications skills with tact and diplomacy. This position maintains interaction with providers and employees throughout the company
• Demonstrate proficiency with standard corporate software applications, including MS Word, Excel, Outlook, Teams, and PowerPoint, as well as some special proprietary applications
• Ability to meet tight deadlines while maintaining high-quality standards
• Manage time to understand new requirements, research industry trends, develop new skills, and study for professional development while meeting project deadlines
• Expand knowledge of industry best practices and trends in ACA/MA risk adjustment
• Ability to accurately interpret CMS guidelines for the purpose of refining and implementing procedures that maintain high standards for the timely and accurate reporting of actionable information to relevant stakeholders
• Timely, creative thinking and writing ability in providing expertise and guidance on risk adjustment and which can have a significant impact on achieving corporate objectives

Bonus if you have

• Masters degree preferred.
• Experience with and an understanding of data warehouse, data extraction tools, and analytics software and methods is highly preferred.
• Encounter Data Processing System (EDPS), and MA Stars reporting requirements and the risk adjustment and MA Stars models and factors is highly preferred.

Benefits & Perks

• Base compensation is only one component of your competitive Total Rewards package
  • Incentive pay program (EPIP)
  • Health/Vision/Dental insurance
  • 6 weeks paid parental leave for new mothers and fathers
  • Fertility/Adoption assistance
  • 2 weeks paid caregiver leave
  • 5% 401(k) plan matching
  • Tuition reimbursement
  • Health & fitness benefits, discounts and resources

Our Commitment to Diversity, Equity, Inclusion, and Belonging

At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of diversity, equity, inclusion, and belonging (DEIB), where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law.

We believe that embracing diversity and authentically promoting inclusion, equity, and belonging among our team members is crucial to our collective success. By intentionally recruiting, developing, and retaining a diverse pool of talent, we cultivate an environment where everyone feels valued, heard, and empowered to contribute. Accommodations are available for applicants with disabilities upon request, ensuring an inclusive and accessible hiring process for all.