Risk Adjustment Data Analyst III

November 14

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NJM Insurance Group

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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 submission, monitoring and contributing to Risk Adjustment Data Submission and Validation. • Collaborate with internal and external stakeholders involved in Risk Adjustment data submission. • Perform analysis and reporting activities related to risk score calculation, encounter data submission, chart review programs and audits. • Research and document encounter errors in established systems and databases. • Contribute to the creation of technical documents and high level solution designs. • Participate in the development, testing and implementation of system specifications. • Interact with RA leadership to create predictive models. • Assist in onboarding and coaching of junior analysts. • Conduct gap analysis, data collection and validation related to Risk Adjustment activities. • Contribute to program improvement by designing and implementing business process and system changes. • Use data from internal and external sources to analyze complex encounter inbound/outbound process issues. • Support and participate in internal and external audits as needed. • Produce recurring and ad-hoc reports for business stakeholders for risk adjustment optimization. • Remain informed and updated on industry changes.

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. • Additional Licensing, Certifications, Registrations 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