JOB DESCRIPTION

Health Business Analyst - Risk Adjustment & Quality Analytics

The Health Business Analyst within the Commercial Risk Adjustments and Quality Analytics team will assist in technical and analytical projects with a focus on targeting, investigating, summarizing and evaluating enrollment and claims data in support of ACA risk adjustment and/or HEDIS quality programs. The ideal candidate will have strong technical skills, with a combination of dataanalytical experience, great communication skills and a natural curiosity tounderstand health insurance concepts.

The Skills You Bring:

• Analyze enrollment, medical and pharmacy claims, risk adjustment scoring and/or HEDIS quality data to support business operations, prioritization and member or provider outreach campaigns to help ensure accurate capture and closure of risk or quality care gaps
• Assist in the evaluation of new or revised regulations in support of ACA Risk Adjustment and HEDIS quality programs, using analytical methods and techniques
• Monitor and evaluate patterns, costs and trends as they relate to enrollment, claims, risk score and HEDIS quality data
• Produce basic spreadsheets, documents and presentations that are well-documented and easy to follow (e.g., Excel, PowerPoint, Tableau)
• Modify existing programs and write basic SAS or SQL programs for data extraction
• Proactively seek training and build knowledge/experience of technical tools, coding languages and data sources

Required:

• 2+ years related analytical work experience with a focus in the health or medical industry or equivalent combination of transferable experience and education
• Master's degree in relevant field can be substituted for work experience requirement
• Bachelor's degree required
• Experience with analytics and inferential statistics
• Experience writing SQL/SAS code or related code

Preferred:

• Bachelor's degree in Business Analytics, Statistics, Health Economics or similar program
• Master's degree in a related field
• Working knowledge of ACA Risk Adjustment program, risk scoring models or EDGE Server submission process
• Working knowledge of HEDIS Quality measures and programs
• Working knowledge of Federal Employee Programs (FEP) programs