Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Job Summary:

The Risk Adjustment Data Analyst II will contribute to the end-to-end encounter process workflow and supports program activities around risk adjustment data submissions to federal & state agencies on a timely basis, ensuring the accuracy and compliance of the data submitted.
The analyst will also be responsible for timely completion of projects, including timeline development & maintenance as it pertains to encounter and risk adjustment data. The analyst will provide project support as required.

Responsibilities:

• Collaborate with internal and external stakeholders involved in Risk Adjustment data submission, as well as all other mandatory aspects of Risk Adjustment.

• Support Risk Adjustment Data Validation (RADV) audit, including exporting and analyzing data and providing data support for operational team.

• Maintain and implement technical documents and high level solution designs.

• Identify process improvements by researching root causes for data deficiencies, data leakage, and encounter data rejections resolution.

• Actively contribute to error resolutions of both prospective and retrospective encounter data submission reconciliation processes.

• Conduct gap analysis, data collection and validation related to Risk Adjustment activities.

• Participate in the development, testing and implementation of system specifications.

• Develop and maintain tracking reports across multiple processes.

• Participate in the peer review process.

• Performs other functions as assigned by management.

Education/Experience:

• Bachelor's degree preferred from an accredited college or university preferably in Computer Science, Data Science or other strong analytical field.

• Requires a minimum of three (3) years of experience with programming or analytics, preferably in health care, 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.

Knowledge:

• Knowledge in Excel (including pivot tables) and Access required.

• 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.

Skills and Abilities:

• Strong analytical, research and problem-solving skills.

• Attention to detail.

• Proficiency in Microsoft software applications.

• Proficiency in either SAS or SQL.

• Ability to perform and interpret a variety of data analyses.

Travel (If Applicable):

Salary Range:

$68,500 - $91,665

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:

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement

Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.

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.