Blue Cross and Blue Shield of Kansas has an opportunity for a Risk Adjustment Analyst to join our team. This position is responsible for reporting accurate and timely Medicare Advantage (MA) risk adjustment data to leadership and Centers for Medicare & Medicaid Services (CMS), executing and monitoring risk adjustment and MA Stars improvement initiatives in coordination with multiple corporate divisions and vendors, and developing estimates of risk adjustment payments. “This position is eligible to work hybrid (9 or more days a month 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? Professional Growth Opportunities: Advance your career with ongoing training and development programs both through our internal Blue University and external opportunities. Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans. Stability: 80 years of commitment, compassion, and community Inclusive Work Environment: We pride ourselves on fostering a diverse and inclusive workplace where everyone is valued and respected. Balance: paid vacation and sick leave with paid maternity and paternity available immediately upon hire Compensation $80,720 - $96,000 Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The salary 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 salaries 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 Develop and maintain subject matter expert knowledge of the CMS ACA/MA risk adjustment program requirements and methodologies. Review CMS communications pertaining to ACA/MA risk adjustment. Propose policy and procedure changes to comply with any new CMS requirements. Facilitate accurate and timely ACA/MA risk adjustment reporting to CMS, to maintain compliance with internal and federal requirements and optimize revenue. Maintain reporting and modeling tools to achieve that end and identify and develop tool improvements. 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. Help with data analysis for the annual audits. Analyzes HEDIS data, including data audits, roadmap (data flow process) documentation, reports, statistical analysis, medical record extraction, and other HEDIS-related activities as needed. Assist with the development of provider education materials related to ACA/MA risk adjustment. Participate in the ACA/MA Risk Adjustment Data Validation (RADV) audit process, as they arise, working with external parties and internal staff to meet CMS requirements. Analyze risk performance for trend identification and to inform strategy development. Assist with the development of ACA/MA risk adjustment improvement initiatives & incentive programs. What you need Bachelor’s Degree in Mathematics, Statistics, Health Care or Business Administration, Finance, or related field is required. Two years of related experience is required. Skilled with Microsoft Word, Excel, and Access. Ability to work with computer programming and PC data analysis tools such as SQL; and statistical software applications, such as R, SAS, or Minitab. Bonus if you have Experience with and knowledge of compliance, information systems, and other health insurance administration concepts and principles. Understanding of CMS Risk Adjustment Processing System (RAPS), Encounter Data Processing System (EDPS), and MA Stars reporting requirements and the risk adjustment and MA Stars models and factors. Benefits & Perks Base salary 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 Posting Close Date Pay Rate Type Salary For more than 70 years, Blue Cross and Blue Shield of Kansas has built a reputation of trust. As we move forward in this new era of health care we want to continue that tradition. Whether a member needs Blue Cross to cover an annual check-up or give them peace of mind during a major medical crisis, we want our members to know they can trust BCBSKS to meet their needs. Our mission: Being the insurer Kansans trust with their health. ***Equal Opportunity Employer/Veterans/Disabled*** ***Blue Cross Blue Shield of Kansas invites any applicant and/or employee to review the Company’s written Affirmative Action Plan. This plan is available for inspection upon request by contacting the EEO Office at (785)291-8639.***