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Risk Adjustment Analyst - Newark, United States - Horizon Blue Cross Blue Shield
Description
Risk Adjustment Analyst page is loaded **Risk Adjustment Analyst**
**Risk Adjustment Analyst**
locationsNewark, NJ - Hybrid time typeFull time posted onPosted 8 Days Ago job requisition id **Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware**
Job Summary:
Perform analytical studies related to Risk Adjustment as well as the Reinsurance and Risk Corridors (collectively known as the 3R-s). Assist in implementing the 3R-s under ACA. Coordinate with Medicare and Medicaid risk adjustment programs. This position reports to Manager, Risk Adjustment Programs.
The primary responsibility is to perform risk adjustment analytical studies that involve manipulations of large amounts of data; apply advanced programming techniques to streamline the analysis.
Conduct gap analysis and data collection and validation. Analyze enrollment and claims data for patterns and trends to identify opportunity to improve documentation and coding.
Identify and implement improvements to the Edge Server data. Coordinate with IT and other departments involved in running Edge Server as well as all other mandatory aspects of the 3R-s.
Coordinate the work of vendors in identifying and managing chart retrievals. Track vendor progress in meeting deadlines, reporting accurate and complete data.
Coordinate the work on government audit of risk adjustment data (RADV Audit).
Coordinate provider education and member outreach efforts as related to risk adjustment.
Forecast 3R payments and receivables and create reports for senior leadership.
**Qualifications:**
BA/BS in Mathematics, Statistics, Computer Science, Actuarial Science preferred or equivalent work experience
5-7 years with both hands on and oversight experience with predictive analytics in health care industry, 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.
**Knowledge:**
Project management skills.
Expertise with statistical software tools in order to perform data manipulation and analysis
Computer skills: Excel (including pivot tables), Access (including VBA),
Excellent knowledge of SAS and SQL is a must.
Knowledge of Informatica software 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. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.**
**Please Be Advised**
At this time, Horizon BCBSNJ will require all new hires, regardless of role, work location or work arrangement to be vaccinated against COVID-19. Vaccinated is defined as having received the second dose of the Pfizer or Moderna two-dose primary vaccine series or a single dose of the J&J vaccine.
**Our Vision**
We are New Jerseys health solutions leader driving innovations that improve health care quality, affordability and member experience in the markets we serve.
