Job Description
Job Summary
The Risk Adjustment Data Analyst III plays a crucial role in the submission, monitoring, and validation of Risk Adjustment Data within key regulatory guidelines. This seasoned analyst is responsible for overseeing the timely completion of projects, including timeline development and maintenance related to encounter and risk adjustment data.
Main Responsibilities
Collaborate with internal and external stakeholders on Risk Adjustment data submission and other mandatory aspects.
Perform analysis and reporting activities related to risk score calculation, encounter data submission, chart review programs, audits, and performance metrics.
Research and document encounter errors in established systems and databases with statistical trend analysis.
Develop recommendations based on data and industry standards.
Additional Tasks
Create technical documents and high-level solution designs.
Participate in system specification development, testing, and implementation.
Interact with RA leadership to create predictive models using data mining or analysis.
Assist in onboarding and coaching junior analysts, participate in peer review processes.
Conduct gap analysis, data collection, and validation related to Risk Adjustment activities.
Design and implement business process and system changes.
Analyze complex encounter inbound/outbound process issues to provide insight to decision-makers.
Support and participate in internal and external audits as needed.
Requirements
Education
Bachelor's degree from an accredited college or university in Computer Science, Data Science, or a strong analytical field (preferred).
Master's degree (a plus).
Experience
Minimum of five years of experience in programming or analytics, preferably in healthcare, insurance, or a related field.
Clinical and medical claims data, disease diagnostic coding practice (a plus).
Experience manipulating large amounts of clinical and medical claims data in the healthcare industry, insurance, or a related field.
Programming and statistical software (e.g., SAS), various databases, and data sources (required).
Licenses and Certifications
SAS, Oracle, or SQL certification (a plus).
Knowledge and Skills
Advanced knowledge in Excel (including pivot tables) and Access required.
Advanced knowledge of SAS, Oracle, or SQL required.
Knowledge of R and Python (a plus).
Knowledge of risk adjustment programs for Medicare/Medicaid, or risk mitigation programs under ACA (a plus).
Strong analytical, research, and problem-solving skills; experience with relational databases and techniques.
Strong attention to detail.
Written and oral communication skills.
Proficiency in Microsoft software applications.
Ability to perform and interpret various data analyses.
Demonstrated ability to evaluate and interpret complex data.
Demonstrated ability to handle multiple tasks with competing priorities.
The Risk Adjustment Data Analyst III plays a crucial role in the submission, monitoring, and validation of Risk Adjustment Data within key regulatory guidelines. This seasoned analyst is responsible for overseeing the timely completion of projects, including timeline development and maintenance related to encounter and risk adjustment data.
Main Responsibilities
Collaborate with internal and external stakeholders on Risk Adjustment data submission and other mandatory aspects.
Perform analysis and reporting activities related to risk score calculation, encounter data submission, chart review programs, audits, and performance metrics.
Research and document encounter errors in established systems and databases with statistical trend analysis.
Develop recommendations based on data and industry standards.
Additional Tasks
Create technical documents and high-level solution designs.
Participate in system specification development, testing, and implementation.
Interact with RA leadership to create predictive models using data mining or analysis.
Assist in onboarding and coaching junior analysts, participate in peer review processes.
Conduct gap analysis, data collection, and validation related to Risk Adjustment activities.
Design and implement business process and system changes.
Analyze complex encounter inbound/outbound process issues to provide insight to decision-makers.
Support and participate in internal and external audits as needed.
Requirements
Education
Bachelor's degree from an accredited college or university in Computer Science, Data Science, or a strong analytical field (preferred).
Master's degree (a plus).
Experience
Minimum of five years of experience in programming or analytics, preferably in healthcare, insurance, or a related field.
Clinical and medical claims data, disease diagnostic coding practice (a plus).
Experience manipulating large amounts of clinical and medical claims data in the healthcare industry, insurance, or a related field.
Programming and statistical software (e.g., SAS), various databases, and data sources (required).
Licenses and Certifications
SAS, Oracle, or SQL certification (a plus).
Knowledge and Skills
Advanced knowledge in Excel (including pivot tables) and Access required.
Advanced knowledge of SAS, Oracle, or SQL required.
Knowledge of R and Python (a plus).
Knowledge of risk adjustment programs for Medicare/Medicaid, or risk mitigation programs under ACA (a plus).
Strong analytical, research, and problem-solving skills; experience with relational databases and techniques.
Strong attention to detail.
Written and oral communication skills.
Proficiency in Microsoft software applications.
Ability to perform and interpret various data analyses.
Demonstrated ability to evaluate and interpret complex data.
Demonstrated ability to handle multiple tasks with competing priorities.
💡 Quick Summary
Seeking a career-building opportunity? The Risk Adjustment Data Analyst III Remote NJ position is now open for candidates interested in the Government Job Alert sector. This role in Allandale offers a professional environment and growth potential.
Requirement Snapshot: Candidates should possess basic communication skills, a proactive attitude, and the ability to work in a team. Experience in Government Job Alert is a plus.
