Risk Adjustment and Public Reporting Analyst at Carle Health
Champaign, Illinois, United States — full-time
Overview
The Risk Adjustment and Public Reporting Analyst is responsible for ensuring the accuracy and validity of risk adjustment methodologies and public reporting readiness. This role involves auditing, analyzing, and validating clinical and administrative data that influence risk-adjusted quality outcomes. The Analyst will collaborate closely with clinical departments, coding teams, and quality management to identify documentation gaps and support compliance with evolving regulatory standards.
Qualifications
Certifications: IHI Open School Basic Certificate in Quality and Safety within 1 year - Institute for Healthcare Improvement (IHI). Medical Terminology within 1 year. Certification provided by Carle Health.
Education: Bachelor's Degree: Related Field
Responsibilities
Risk Adjustment & Public Reporting Analyst (RAPRA): Owns risk-adjustment validity and public reporting readiness, including audits tied to methodology, coding/documentation impact, and regulatory/program change tracking across CMS/Vizient/public programs.The Risk Adjustment and Public Reporting Analyst is responsible for proactively auditing, analyzing, and validating clinical and administrative data that drive risk‑adjusted quality outcomes and publicly reported performance.This role ensures the accurate representation of patient acuity, organizational performance, and compliance with evolving regulatory and methodological standards across CMS, Vizient, and other public reporting programs.Proactively audit data elements that align with risk adjustment methodoligiesSupport analysis and reporting for CMS and other public reporting programs (e.g., Care Compare, Star Ratings, Leapfrog, U.S. News where applicable)Responsible for exporting, analyzing variations, outliers and opportunity areas and distributing reports form the CMS Hospital Quality Reporting ProfileDevelop reports to support deliverables for a variety of stakeholders.Work closely with PI Specialist to present findings at opportunity review meetingsAnalyze and validate risk‑adjusted quality measures to ensure accurate representation of patient acuity and organizational performanceEvaluate the impact of documentation, coding, and comorbidity capture on risk‑adjusted outcomes (e.g., mortality, complications, readmissions)Collaborate with CDI and Coding teams to identify gaps affecting risk adjustment and quality outcomesPerform case‑level and population‑level analyses to support appeals, exclusions, and methodological reviewsSupport analysis and reporting for CMS and other public reporting programs (e.g., Hospital Compare, Star Ratings, Leapfrog, U.S. News where applicable)Assess the impact of risk adjustment methodologies on publicly reported outcomesTrack methodological updates and measure changes affecting public reporting programs
About Us
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