• Job Description

  Req#: 2037828

  • This position is posted internal within the department only.
  • JOB SUMMARY/PURPOSE

    • Responsible for business intelligence and analytics related to risk adjustment initiatives. This involves oversight, monitoring, and enhancement of risk adjustment data quality across the different internal and external systems; performance reporting and dashboarding; the creation of target lists and program ROIs and effectiveness; and other ad-hoc analysis. Serves as the subject matter expert in risk adjustment.

  • DEPARTMENT DESCRIPTION
    • Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services’ self-funded employee health benefit plan. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services’ mission of Building Healthier Communities Together.
  • EXPERIENCE/EDUCATION/QUALIFICATIONS
    • Bachelor's Degree or equivalent experience required.
    • Four (4) years risk adjustment experience in a health care or insurance environment required.
    • Experience manipulating and analyzing large data sets and files (e.g., MMR, MOR, MAO-004, MAO-002) required.
    • Experience with ICD-10, CM, and CPT coding terminology required.
    • Experience with computer applications, including MS Office (Excel, Word, PowerPoint) required.
    • Experience with SQL, SAS, or other BI tools preferred.
  • KNOWLEDGE/SKILLS/ABILITIES
    • Effective written and verbal communication skills to perform group presentations, tactfully discuss issues, and listen to and understand concepts, rules and procedures. Ability to work with all levels within the organization, facilitate communication, and effectively document related activities.
    • Ability to identify complex problems, review related information, employ creativity and alternative thinking to develop and evaluate options and implement solutions.
    • Ability to recommend solutions and strategies to upper management based on analysis.
    • Advanced knowledge of CMS-HCC risk algorithm.
    • Advanced proficiency with Microsoft Excel.
  • PHYSICAL DEMANDS

    • Rarely (1 - 10% of the time)	Occasionally (11 - 33% of the time)	Frequently (34 - 66% of the time)	Continually (67 – 100% of the time)
      CLIMB - STAIRS LIFT (Floor to Waist: 0"-36") 0 - 20 Lbs LIFT (Knee to chest: 24"-54") 0 – 20 Lbs LIFT (Waist to Eye: up to 54") 0 - 20 Lbs CARRY 1-handed, 0 - 20 pounds BEND FORWARD at waist KNEEL (on knees)	STAND WALK – LEVEL SURFACE ROTATE TRUNK Standing REACH - Upward PUSH (0 - 20 pounds force) PULL (0 - 20 pounds force)	SIT CARRY 2-handed, 0 - 20 pounds ROTATE TRUNK Sitting REACH - Forward	MANUAL DEXTERITY Hands/wrists FINGER DEXTERITY PINCH Fingers GRASP Hand/Fist

• About the company

  The Samaritan Health Services is a non-profit, integrated delivery healthcare system consisting of five hospitals in Oregon and is headquartered in Corvallis, Oregon.

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