Job Description
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
Find it here. Discover the job, the career, the purpose you were meant for. At Carle Health, we're committed to fostering a workplace where every team member feels valued, respected and empowered, where passion and purpose come together to positively impact the lives of our patients and our communities. Find it all at Carle Health.
Our nearly 17,000 team members and providers work together to support patient care across central and southeastern Illinois. We’ve grown to include eight, award-winning hospitals and a multispecialty provider group with more than 1,500 doctors and advanced practice providers. We’re developing the next generation of providers and healthcare professionals through Carle Illinois College of Medicine, the world’s first engineering-based medical school, and Methodist College. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet® designations, the nation’s highest honor for nursing care. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: human.resources@carle.com.
Compensation and Benefits
The compensation range for this position is $31.32per hour - $53.87per hour. This represents a good faith minimum and maximum range for the role at the time of posting by Carle Health. The actual compensation offered a candidate will be dependent on a variety of factors including, but not limited to, the candidate’s experience, qualifications, location, training, licenses, shifts worked and compensation model. Carle Health offers a comprehensive benefits package for team members and providers. To learn more visit careers.carlehealth.org/benefits.
Job Tags
Local area, Shift work