Risk Adjustment Data Analyst

Job Title: Risk Adjustment Data Analyst
Job Location: Newark, NJ(Hybrid)
Job Type: Full Time

Job Summary:
The Data Analyst leads the technology process for the end-to-end Risk Adjustment Processing System (RAPS) and Encounter Data Processing System (EDPS) data flow and works within key regulator guidelines for acceptable data submission. Using SQL and SAS programs lead the gathering of data for submissions Risk Adjustment. As the senior analyst of data will be responsible for leading the manipulation of large amounts of data and managing data submission with minimum supervision

Responsibilities:

Lead the coordination with IT and other departments involved in running Edge Server and/or Risk Adjustment data submission, as well as all other mandatory aspects of Risk Adjustment and Risk Adjustment Data Validation (RADV)
Oversees the creation of technical documents and high-level solution designs
Recommends best practices for delivering business solutions
Leads the development, testing, and implementation of system specifications
Oversee the coordination with IT and other departments involved in running Edge Server and/or Risk Adjustment data submission, as well as all other mandatory aspects of Risk Adjustment and Risk Adjustment Data Validation (RADV)
Interact with RA leadership to create predictive models using information obtained from data mining or analysis
Lead, manage, develop and train less-experienced staff by providing guidance to other analysts and quality review their work
Conduct gap analysis, data collection and validation related to Risk Adjustment activities
Performs other functions as assigned by management

Knowledge:

Requires knowledge of user-oriented programming languages including SQL and/or RAMIS
Requires knowledge related to clinical care (i.e. nursing, social work)
Prefers candidates with knowledge of Plan products and files
Requires strong analytical abilities and the ability to report findings accurately
Requires excellent verbal and written communication skills
Requires strong interpersonal skills and the ability to interact with all management levels
Requires the ability to utilize logic in problem-solving
Requires the ability to coordinate projects

Education/Experience:

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

MS or MA is a plus
IT experience is strongly preferred
Actuarial experience and passing Actuarial exams is a plus
Requires 7 years experience with analytics in health care, insurance, or related field; clinical and medical claims data and disease diagnostic coding practice a plus
Knowledge of risk adjustment programs for Medicare/Medicaid, or risk mitigation programs under ACA, is a plus
Strong analytical skills; experience with relational databases and techniques
Strong problem-solving skills
Strong written and oral communication skills
Expertise with statistical software tools in order to perform data manipulation and analysis