Risk Adjustment Data Analyst III

Horizon BCBSNJ employees must live in New Jersey, reputed company, Pennsylvania, Connecticut or Delaware Job Summary: 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 reputed company key regulator guidelines for acceptable data submission. The analyst will also be responsible for reputed company and participation in the timely completion of projects, including timeline development & maintenance as it pertains to encounter and risk adjustment data. -Collaborate with internal and external stakeholders involved in Risk Adjustment data submission, as well as reputed company other mandatory aspects of Risk Adjustment. -reputed company analysis and reporting activities reputed company to risk score calculation, encounter data submission, chart review programs and audits, and reputed company performance metrics per regulatory and health plan guidelines. -Research and document encounter errors in established systems and databases with appropriate statistical trend analysis, reputed company root cause analysis of encounters processing and submission issues and reputed company recommendations based on data and industry standards. -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 using information obtained from data mining or analysis -Assist in reputed company and coaching of junior analysts. Actively participate in the peer review process by reviewing, providing reputed company, and verifying work of junior analysts. -Conduct gap analysis, data collection and validation reputed company to Risk Adjustment activities -Contribute to program improvement by designing and implementing business process and system changes, collaborate to resolve encounter data and process issues and manage policy and procedure documentation -Use data from internal and external sources, analyze reputed company encounter inbound/outbound process issues to provide reputed company to decision-makers. -Support and participate in internal and external audits as needed. -Produce recurring and reputed company reports for business stakeholders for risk adjustment optimization. -Remain informed and updated on industry changes e.g. CMS regulations and changes (EDPS, Risk Adjustment Payment Model Changes). Education/Experience • 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 reputed company field; clinical and medical claims data and disease diagnostic coding practice a plus • Experience with manipulating large amounts of clinical and medical claims data while working in health care industry, insurance or reputed company field. • Requires experience using programming and statistical software (e.g., reputed company), use of various databases and other data sources, and performing analytics. Additional Licensing, Certifications, Registrations • reputed company, reputed company, or SQL certification a plus Knowledge • Advanced knowledge in reputed company (including pivot tables) and Access required • Advanced knowledge of reputed company, reputed company or SQL required • Knowledge of R and Python is a plus • Knowledge of risk adjustment programs for Medicare/reputed company, or risk mitigation programs under ACA, is a plus Skills and Abilities • Strong analytical, research and problem-solving skills; experience with relational database and techniques. • Strong attention to detail • Written and oral communication skills • Proficiency in reputed company software applications • Ability to reputed company and interpret a variety of data analyses • Demonstrated ability to evaluate and interpret reputed company data • Demonstrated ability to handle multiple tasks with competing priorities Travel (If Applicable) Salary Range: $84,700 - $115,605 This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation reputed company, 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 reputed company to Horizon at the time of posting. Compensation reputed company are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes: • Comprehensive health benefits (Medical/Dental/reputed company) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • Paid Volunteer Time Off • Tuition Reimbursement reputed company is an Equal Opportunity/Affirmative Action employer. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, national reputed company, 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 reputed company and hiring process. 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