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Risk Adjustment Data Analyst
  • Python
  • SQL
  • SAS
  • Excel
  • Database
  • Data Mining
Horizon Blue Cross Blue Shield of New Jersey
Newark, NJ 07105
143 days ago

Job Summary:

The Data Analyst leads the technology process for the end to end Risk Adjustment Processing System (RAPS) and Encounter Data Processing System (EDPS) data flow and works within key regulator guidelines for acceptable data submission. Using SQL and SAS programs lead the gathering of data for submissions Risk Adjustment. As the senior analyst of data, will be responsible for leading the manipulation of large amounts of data and managing data submission with minimum supervision

  • Lead the coordination with IT and other departments involved in running Edge Server and/or Risk Adjustment data submission, as well as all other mandatory aspects of Risk Adjustment and -Risk Adjustment Data Validation (RADV)
  • Oversees the creation of technical documents and high level solution designs
  • Recommends best practices for delivering business solutions
  • Leads the development, testing and implementation of system specifications
  • Oversee the coordination with IT and other departments involved in running Edge Server and/or Risk Adjustment data submission, as well as all other mandatory aspects of Risk Adjustment and Risk Adjustment Data Validation (RADV)
  • Interact with RA leadership to create predictive models using information obtained from data mining or analysis
  • Lead, manage, develop and train less-experienced staff by providing guidance to other analysts and quality review their work
  • Conduct gap analysis, data collection and validation related to Risk Adjustment activities
  • Performs other functions as assigned by management

Qualifications:

  • BA/BS in Mathematics, Statistics, Computer Science, Actuarial Science or other strong analytical field required; MS or MA is a plus
  • IT experience strongly preferred
  • Actuarial experience and passing of Actuarial exams is a plus
  • Requires 7 years’ experience with analytics in health care, insurance or related field; clinical and medical claims data and disease diagnostic coding practice a plus
  • Knowledge of risk adjustment programs for Medicare/Medicaid, or risk mitigation programs under ACA, is a plus
  • Strong analytical skills; experience with relational database and techniques
  • Strong problem solving skills
  • Strong written and oral communication skills
  • Expertise with statistical software tools in order to perform data manipulation and analysis

Computer skills:

  • Advanced knowledge in Excel (including pivot tables) and Access required
  • Advanced knowledge of SAS or SQL required
  • Knowledge of R and Python is a plus

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law.

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