- 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
- 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
- Comprehensive health benefits (Medical/Dental/Vision)
- Retirement Plans
- Generous PTO
- Incentive Plans
- Wellness Programs
- Paid Volunteer Time Off
- Tuition Reimbursement
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Risk Adjustment Data Analyst IV - Newark, United States - Horizon Blue Cross Blue Shield of New Jersey
Description
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or DelawareJob 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:
$94,900 - $129,570
This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes: