Risk Adjustment Data Analyst III

Yesterday

Apply Now

Receive Emails with Similar Jobs

NJM Insurance Group

WebsiteLinkedInAll Job Openings

Auto Insurance • Workers'​ Compensation Insurance • Homeowners Insurance • Commercial Auto Insurance • Renters Insurance

1001 - 5000

Description

• 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. • 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. • Help to onboard and coach junior analysts and actively participate in the peer review process by verifying work of junior analysts.

Requirements

• Bachelor’s degree preferred from an accredited college or university preferably in Computer Science, Data Science or other strong analytical field. • Master’s degree a plus • Requires a minimum of five (5) years of experience with programming or analytics, preferably in health care, insurance or related field • Experience 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. • SAS, Oracle, or SQL certification a plus • Advanced knowledge in Excel (including pivot tables) and Access required • Advanced knowledge of SAS, Oracle or SQL required • Knowledge of R and Python is a plus • Knowledge of risk adjustment programs for Medicare/Medicaid, or risk mitigation programs under ACA, is a plus

Benefits

• Comprehensive health benefits (Medical/Dental/Vision) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • Paid Volunteer Time Off • Tuition Reimbursement