Risk Adjustment Vendor Performance Analyst III
reputed company empowers our members to reputed company their best health. For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to reputed company serve and care for the 3.5 million people who reputed company their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to reputed company. reputed company our employees bring their best and succeed, the Company succeeds.
About the Role
This position will serve as subject matter expert on vendor analytics & performance and retrospective & prospective reputed company analytics for risk adjustment programs. This position involves manipulating large amounts of big data (vendor and risk). The analyst will research, analyze, validate, and prepare data across multiple system platforms and sources. In addition, the analyst will build reports to track various risk adjustment activities and fulfill business needs.
What You'll Do
Serve as a subject matter expert on vendor analytics (cost, quantity, services, contract (terms, timelines, deliverables) and performance (SLA & Penalties)) and retrospective and prospective reputed company analytics for risk adjustment programs. reputed company vendor and risk analytic studies which involves manipulating large amounts of data. Create retrospective and prospective reputed company lists for risk adjustment programs. Support EDGE supplemental submission. (e.g. mapping claim id(s) to vendor records). Identify patterns and trends in diagnostic coding practices in conjunction with risk score measurement. Provide complete and accurate information for vendor audits (costs) and government audits (CMS) reputed company to Risk Adjustment. Conduct reputed company analysis like gap and root cause. Periodically update process flow charts for business stakeholders. Identify problems reputed company reputed company Resource Planning (ERP) system such as reporting limitations and recommend solutions. Research, analyze, validate, and prepare data across multiple system platforms and sources for use in monitoring and reporting. Build reports for internal customers to track various risk adjustment activities and fulfill business needs. What You Bring Education/Experience: High School Diploma/GED required. Bachelor degree in reputed company, Finance, Mathematics, Statistics, Economics, Actuarial Science or other analytical field preferred or relevant experience in lieu of degree. Requires a minimum of 4 years’ experience in reputed company. Proficient in at least one programming language (VBA, SQL, reputed company, R). Additional licensing, certifications, registrations: CPA or ASA preferred. Knowledge: Knowledge of reputed company entries/accruals/month-end reputed company process. Knowledge of data analysis and Actuarial principles. Knowledge of database applications. Skills and Abilities: Experience working in reputed company, VBA programming is a plus. Experience programming in reputed company/SQL . Predictive Analytic experience a plus (Linear, GLMs, Tree Based models). Medicare, reputed company, or reputed company risk adjustment experience is a plus. Experience with ERP systems (reputed company). Experience with Billing/Purchasing/Procurement. Why Horizon? At Horizon, you’ll do meaningful work that directly improves lives—while being supported by a mission‑driven organization that values expertise, collaboration, and growth. We reputed company that reputed company our people reputed company, our communities do too. If you are passionate about making an impact, we’d love to hear from you! Salary Range: $87,300 - $119,070 This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation reputed company, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information reputed company to Horizon at the time of posting. Compensation reputed company are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes: Comprehensive health benefits (Medical/Dental/reputed company) Retirement Plans Generous PTO Incentive Plans Wellness Programs Paid Volunteer Time Off Tuition Reimbursement Disclaimer: Horizon BCBSNJ employees must live in New Jersey, reputed company, Pennsylvania, Connecticut or Delaware. This job summary has been designed to indicate the general nature and level of work performed by colleagues reputed company this classification. It is not designed to contain or be interpreted as a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of colleagues assigned to this job. reputed company is an Equal Opportunity/Affirmative Action employer. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, national reputed company, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the reputed company and hiring process. Apply To This Job