Healthcare Encounter Submissions Data Analyst

Capital Blue Cross • Harrisburg, PA

3h

About The Position

This role supports Capital Blue Cross Risk Adjustment Medicare submissions and day-to-day analytics activities that impact the Medicare submission process. The Risk Adjustment Analyst works closely with the Risk Adjustment leader(s) supporting the execution of the Program strategy through analysis and reporting tactics driving results to improve or maintain risk adjustment compliance, cost and revenue, submissions process, and operations. The role will include support in the development of reports, enhancement to existing reports, data analysis, processes, data submission errors/corrections, and methodologies that will inform and enable the Risk Adjustment leader(s) to make informed decisions based on data and drive the execution of the Program strategy and operations effectiveness.

Requirements

• Creating and applying data to problem solve
• Consistent with delivering results on time and high quality/accuracy
• Ability to communicate and summarize complex data processes, findings, etc. in a simple and clear way
• Problem solving and critical thinking mindset that’s oriented to find solutions
• Financial analytics knowledge with data mining principles: predictive analytics, mapping, collecting and complex manipulating data from multiple data systems
• 3 years of experience in risk adjustment and data analytics.
• Financial analytics knowledge with data mining principles: predictive analytics, mapping, collecting and complex manipulating data from multiple data systems.
• Highly skilled in Excel, SAS, Power BI, Snowflake, Sigma and other query/reporting tools.

Nice To Haves

• Preferred: Bachelors or master's degree in Data Analytics, Data Science, Finance, Actuarial, Mathematics or Statistics, Public Health or Health-related Sciences, or Health Administration.
• Project and/or vendor management experience is a plus.

Responsibilities

• Assist and/or develop new reports or analysis, enhance key existent reports and/or analysis processes, and methodologies of the Risk Adjustment Program operations and initiatives.
• Support the implementation and on-going activities of vendor operations and analytics tools. Vendor management activities such as: contract implementation, delegated activities execution from an analytics standpoint, and performance guarantees monitoring process.
• Lead the error correction process to ensure maximum acceptance rates for encounter submissions.
• Develop standardized reporting and controls for vendor’s management and performance monitoring process to ensure appropriate and timely data flow between teams.
• Collaborate with Actuarial to monitor the impact of coding programs on revenue for forecasting and monthly financial statement accruals.
• Data review, monitor and active participant in the completion of submissions for Medicare products (e.g. Encounter submissions).
• Utilize analytics to identify trends, opportunities for improvement, and potential Programs development.
• Participate on new projects, processes and/or workflows.
• Support the development and implementation of remediation strategies (for internal and/or external business partners).
• Support the development and maintenance of the Risk Adjustment tactics effectiveness. Creation of processes, documentation, and reporting infrastructure.

Benefits

• Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level