Data Analyst - Government Markets (Senior/Lead) at Independence Blue Cross LLC in Philadelphia, Pennsylvania

Job Description:

Bring your drive for excellence, team orientation and customer commitment to Independence; help us renew and reimagine our business and shape the future of health care.  Our organization is looking to diversify, grow, innovate and serve, and we are looking for committed, empowered learning-oriented people to join our team.  If this describes you, we want to speak with you.

The Lead Analyst works in partnership with the Commercial Risk Analytics team to support the overall program, with primary focus on Risk Adjustment Data Validation (RADV) activities.  The analyst uses business data/trends to inform business decisions associated with the Risk Adjustment Process.

Responsibilities include:

• Lead Risk Adjustment Data Validation Audit including managing vendor activity and ensuring compliance with CMS regulations


• Analyze provider coding trends to detect risk gaps and opportunities for provider education


• Track and manage vendor performance to ensure compliance with contract terms 


• Participate in vendor contract negotiations


• Responsible to present on RADV error rate estimates and explain the big picture to multiple departments


• Assist in overall oversight of program performance and budget


• Perform complex data analysis, review accuracy of data, and implement procedures in correlation to data


• Provide analytical and decision support to leadership team


• Translate operational metrics into business results & forecasts


• Keep informed of changes in legislation impacting the ACA as it relates to Risk Adjustment

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  Bachelor’s Degree in Business, Data Analytics, or Information Systems or equivalent work experience that provides knowledge of and exposure to fundamental theories, principles and practices.

  
  


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  8+ years' related experience.

  
  


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  Advanced  proficiency with Tableau and SQL is required. 

  
  


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  Advanced analytical skills

  
  


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  ACA experience preferred

  
  


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  Ability to work collaboratively both within department & with matrix partners.

  
  


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  Strong communication (both written and verbal) and strong presentation skills. 

  
  


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  Demonstrated ability to interact with department management and the ability to work in an independent environment is essential. 

  
  


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  Self-motivated, highly organized, and detail oriented as well as above average problem-solving skills required. 

  
  


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  Strong project planning and management. 

  
  


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  Ability to work, and is comfortable in ambiguous situations.

  
  


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  Demonstrated ability to work with business unit partners and corporate management. 

  
  


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  The ability to manage projects and customer expectations to a successful conclusion is essential. 

  
  


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  Level of role commensurate with experience