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At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.
Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com.
Under the general direction of the Director, Risk Adjustment Programs, the Risk Adjustment Data Analyst II is responsible for the technical infrastructure that supports risk adjustment programs. Responsibilities include, but are not limited to:
The development and maintenance of database solutions of simple to moderate complexity.
Accurately documenting query logic both within database builds and in procedures for completion.
Design and execute queries against enterprise data stores in support of departmental needs.
Demonstrated ability to define and apply quality assurance measures, including development and execution of test protocols and scripts that validate work product prior to subsequent review by peers or manager.
Demonstrated analytical aptitude and problem solving skills via consistent recognition of aberrations in complex data sets, with identification and implementation of solutions.
Identify the need for and/or participate in the planning and development of protocols, procedures and operational strategies to modify existing or implement new processes or programs.
Possess understanding of vendor data interface processes and design/execute procedures to validate file transmissions.
Solid knowledge of risk adjustment models (e.g., HCC, CDPS+RX, ACG, etc.) and concepts, as well as other health insurance data sets available to support the program.
Bachelor’s Degree (or combination of education and experience.
Minimum 4+ years of analytic experience with a concentration in data analysis, Medicare/Medicaid Risk Adjustment, or health insurance claim data.
Experience building moderate to complex data solutions using SQL.
Experience with Hadoop and Tableau a plus.
Expert in using MS Office Suite with demonstrated Access and Excel experience.
Solid knowledge of health insurance claim data preferably in a Medicare or Medicaid Managed Care Organization