Risk Adjustment Data Analyst III

Risk Adjustment Data Analyst IIINewark, NJAll employees must live in: New Jersey, New York, Pennsylvania, Connecticut or DelawareCandidates residing near Newark, NJ will be asked to report in a few days onsite a week.Candidates in New York, Pennsylvania, Connecticut, Delaware, or outer NJ areas will be full remote.Salary: $85,000 - $115,605Job Summary:The Risk Adjustment Data Analyst III is a seasoned analyst responsible for playing an active role in submission, monitoring and contributing to the end to end Risk Adjustment Data Submission and Validation within key regulator guidelines for acceptable data submission.The analyst will also be responsible for oversight and participation in the timely completion of projects, including timeline development & maintenance as it pertains to encounter and risk adjustment data.Collaborate with internal and external stakeholders involved in Risk Adjustment data submission, as well as all other mandatory aspects of Risk Adjustment.Perform analysis and reporting activities related to risk score calculation, encounter data submission, chart review programs and audits, and related performance metrics per regulatory and health plan guidelines.Research and document encounter errors in established systems and databases with appropriate statistical trend analysis, perform root cause analysis of encounters processing and submission issues and develop recommendations based on data and industry standards.Contribute to the creation of technical documents and high level solution designsParticipate in the development, testing and implementation of system specificationsInteract with RA leadership to create predictive models using information obtained from data mining or analysisAssist in onboarding and coaching of junior analysts. Actively participate in the peer review process by reviewing, providing insight, and verifying work of junior analysts.Conduct gap analysis, data collection and validation related to Risk Adjustment activitiesContribute to program improvement by designing and implementing business process and system changes, collaborate to resolve encounter data and process issues and manage policy and procedure documentationUse data from internal and external sources, analyze complex encounter inboundoutbound process issues to provide insight to decision-makers.Support and participate in internal and external audits as needed.Produce recurring and ad-hoc reports for business stakeholders for risk adjustment optimization.Remain informed and updated on industry changes e.g. CMS regulations and changes (EDPS, Risk Adjustment Payment Model Changes).EducationExperienceBachelor's degree preferred from an accredited college or university preferably in Computer Science, Data Science or other strong analytical field.Master's degree a plusRequires a minimum of five (5) years of experience with programming or analytics, preferably in health care, insurance or related field; clinical and medical claims data and disease diagnostic coding practice a plusExperience with manipulating large amounts of clinical and medical claims data while working in health care industry, insurance or related field.Requires experience using programming and statistical software (e.g., SAS), use of various databases and other data sources, and performing analytics.Additional Licensing, Certifications, RegistrationsSAS, Oracle, or SQL certification a plusKnowledgeAdvanced knowledge in Excel (including pivot tables) and Access requiredAdvanced knowledge of SAS, Oracle or SQL requiredKnowledge of R and Python is a plusKnowledge of risk adjustment programs for MedicareMedicaid, or risk mitigation programs under ACA, is a plusSkills and AbilitiesStrong analytical, research and problem-solving skills; experience with relational database and techniques.Strong attention to detailWritten and oral communication skillsProficiency in Microsoft software applicationsAbility to perform and interpret a variety of data analysesDemonstrated ability to evaluate and interpret complex dataDemonstrated ability to handle multiple tasks with competing prioritiesWe also provides a comprehensive compensation and benefits package which includes:Comprehensive health benefits (MedicalDentalVision)Retirement PlansGenerous PTOIncentive PlansWellness ProgramsPaid Volunteer Time OffTuition Reimbursement

Created: 2024-11-01