Risk Adjustment Vendor Performance Analyst III

Horizon Blue Cross Blue Shield of New Jersey•Newark, NJ

1d•$87,300 - $119,070

About The Position

This position will serve as subject matter expert on vendor analytics & performance and retrospective & prospective target analytics for risk adjustment programs. This position involves manipulating large amounts of big data (vendor and risk). The analyst will research, analyze, validate, and prepare data across multiple system platforms and sources. In addition, the analyst will build reports to track various risk adjustment activities and fulfill business needs.

Requirements

High School Diploma/GED required.
Bachelor degree in Accounting, Finance, Mathematics, Statistics, Economics, Actuarial Science or other analytical field preferred or relevant experience in lieu of degree.
Requires a minimum of 4 years’ experience in accounting.
Proficient in at least one programming language (VBA, SQL, SAS, R).
Knowledge of accounting entries/accruals/month-end close process.
Knowledge of data analysis and Actuarial principles.
Knowledge of database applications.

Nice To Haves

CPA or ASA preferred.
Experience working in Excel, VBA programming is a plus.
Experience programming in SAS/SQL .
Predictive Analytic experience a plus (Linear, GLMs, Tree Based models).
Medicare, Medicaid, or commercial risk adjustment experience is a plus.
Experience with ERP systems (Workday).
Experience with Billing/Purchasing/Procurement.

Responsibilities

Serve as a subject matter expert on vendor analytics (cost, quantity, services, contract (terms, timelines, deliverables) and performance (SLA & Penalties)) and retrospective and prospective target analytics for risk adjustment programs.
Perform vendor and risk analytic studies which involves manipulating large amounts of data.
Create retrospective and prospective target lists for risk adjustment programs.
Support EDGE supplemental submission. (e.g. mapping claim id(s) to vendor records).
Identify patterns and trends in diagnostic coding practices in conjunction with risk score measurement.
Provide complete and accurate information for vendor audits (costs) and government audits (CMS) related to Risk Adjustment.
Conduct ad-hoc analysis like gap and root cause.
Periodically update process flow charts for business stakeholders.
Identify problems within Enterprise Resource Planning (ERP) system such as reporting limitations and recommend solutions.
Research, analyze, validate, and prepare data across multiple system platforms and sources for use in monitoring and reporting.
Build reports for internal customers to track various risk adjustment activities and fulfill business needs.