Job description
Job Brief
This technical position strongly prefers SQL Server programming experience. Remote eligible
Your career starts now. We’re looking for the next generation of health care leaders.
At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.
Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com.
Under the general direction of the Director, Risk Adjustment Programs, the Risk Adjustment Data Analyst III is responsible for the technical infrastructure that supports risk adjustment programs.
Responsibilities include, but are not limited to:
- The development and maintenance of complex database solutions that may include forms, reports and/or complex data extraction, accurately documenting query logic both within database builds and in procedures for completion.
- Demonstrated ability to define and apply quality assurance measures, including development and execution of test protocols and scripts that validate work product prior to subsequent review by peers or manager and performs quality audit function for team.
- Ability to transform large data extracts into information that supports management needs to monitor departmental operations and/or measure program success.
- Demonstrated superior analytical aptitude and problem solving skills via consistent recognition of aberrations in complex data sets, with identification and implementation of solutions.
- Lead work sessions/projects with cross organization teams to perform root cause analysis and correct issues.
- Identify the need for and/or participate in the planning and development of protocols, procedures and operational strategies to modify existing or implement new processes or programs.
- Possess sufficient skill and experience to act as Subject Matter Expert for all assigned vendor activities, risk adjustment models (e.g., HCC, CDPS+RX, ACG, etc.) and concepts, as well as other health insurance data sets available to support the program.
Education/ Experience:
- Bachelor’s Degree (or combination of education and experience).
- Minimum 6+ years of analytic experience with concentration in data analysis for Medicare/Medicaid Risk Adjustment, program.
- Expert in using MS Office Suite with demonstrated mastery of all MS Access and Excel.
- Solid knowledge of Health Insurance, Claims Data, Manage Care, Medicare and/or Medicare plans.
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