Risk Adjustment & Quality Analytics - Health Business Analyst
Gainesville, FL  / Jacksonville, FL  / Tampa, FL  / Orlando, FL ...View All
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Job Description

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

We are an Equal Opportunity Employer/Protected Veteran/Disabled.

Florida Blue is an Equal Opportunity Employer - Protected Veteran/Disabled

 

Job Summary
Company
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Education
Bachelor's Degree
Required Experience
2+ years
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