Healthcare Data Analyst - Risk Adjustment Medicare at Capital Blue Cross

Harrisburg, Pennsylvania, United States -

Full Time

Start Date

Immediate

Expiry Date

29 May, 26

Salary

0.0

Posted On

28 Feb, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Data Analysis, Reporting, Risk Adjustment, Data Mining, Predictive Analytics, Excel, SAS, Power BI, Snowflake, Sigma, Vendor Management, Problem Solving, Critical Thinking, Communication, Data Review, Process Documentation

Industry

Insurance

Description

Position Description Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market-driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. 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. At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.” This role is responsible for supporting Capital Blue Cross Risk Adjustment Program analytics day to day activities impacting the programs strategy and operations. The Risk Adjustment Analyst works closely with the Risk Adjustment & Stars Programs Management leader(s) supporting the execution of the Program strategy through analysis and reporting tactics driving results to improve or maintaining 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, 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. Responsibilities and Qualifications 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. Develop standardized reporting and controls for vendor’s management and performance monitoring process to ensure appropriate and timely data flow between teams. Prepare contracts, projects, and/or initiatives performance reports, gap analysis, etc. based on key performance indicators. Communicate performance updates and findings to leadership. Collaborate with Actuarial to project and 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 and Commercial/ACA products (e.g. RAPS/EDPS submissions). Utilize analytics to identify trends, opportunities for improvement, and potential Programs development. Collaborate with the Risk Adjustment & Stars Programs leader (s) and team to monitor and project year to date and end of year performance. 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. Skills: 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 Knowledge: Financial analytics knowledge with data mining principles: predictive analytics, mapping, collecting and complex manipulating data from multiple data systems Experience: 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. Project and/or vendor management experience is a plus. Education and Certifications: Preferred: Bachelor's or master's degree in data analytics, Data Science, Finance, Actuarial, Mathematics or Statistics, Public Health or Health-related Sciences, or Health Administration. Physical Demands: While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see. The employee must occasionally lift and/or move up to 5 pounds. About Us We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.

Responsibilities

This role supports the daily activities of the Risk Adjustment Program analytics, focusing on strategy execution through analysis and reporting to maintain compliance, manage cost and revenue, and improve submission processes. Responsibilities include developing and enhancing reports, data analysis, and methodologies to inform leadership decisions and drive program effectiveness.