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Risk Adjustment Analyst

Company: Horizon Blue Cross Blue Shield of New Jersey
Location: Newark
Posted on: September 13, 2019

Job Description:

Job Summary:

Perform analytical studies related to Risk Adjustment. Assist in implementing the RA under ACA. Coordinate with Medicare and Medicaid risk adjustment programs.



Responsibilities:

* The primary responsibility is to perform risk adjustment analytical studies that involve manipulations of large amounts of data; apply advanced programming techniques to streamline the analysis.

* Conduct gap analysis and data collection and validation. Analyze enrollment and claims data for patterns and trends to identify opportunity to improve documentation and coding.

* Identify and implement improvements to the Edge Server data. Coordinate with IT and other departments involved in running Edge Server as well as all other mandatory aspects of the 3R s.

* Coordinate the work of vendors in identifying and managing chart retrievals. Track vendor progress in meeting deadlines, reporting accurate and complete data.

* Coordinate the work on government audit of risk adjustment data (RADV Audit).

* Coordinate provider education and member outreach efforts as related to risk adjustment.

* Forecast RA payments and receivables and create reports for senior leadership.

Knowledge:

* Project management skills.

* Expertise with statistical software tools in order to perform data manipulation and analysis

* Computer skills: Excel (including pivot tables), Access (including VBA),

* Excellent knowledge of SAS and SQL is a must.

* Knowledge of Informatica software is a plus

Education/Experience

* BA/BS in Mathematics, Statistics, Computer Science, Actuarial Science or other strong analytical field

* 5-7 years with both hands on and oversight experience with predictive analytics in health care industry, insurance or related 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 related field.

* 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 written and oral communication skills

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.

Requirements:

Education
Bachelors

Job Level
Individual Contributor

Expertise
Actuarial & Underwriting

Job Type
Full Time

Location
Newark, NJ

Keywords: Horizon Blue Cross Blue Shield of New Jersey, Newark , Risk Adjustment Analyst, Professions , Newark, New Jersey

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