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Risk Adjustment Analyst

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POST DATE 9/16/2016
END DATE 1/2/2017

Horizon Blue Cross Blue Shield of New Jersey Newark, NJ

Newark, NJ
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Entry Level (0 - 2 years)
Bachelors Degree


Job Summary:

This position reports to Manager, Risk Adjustment Programs. The primary responsibility is to perform risk adjustment analytical studies that involve manipulations of large amounts of data; apply advanced programming related to Medicare and Medicaid Risk Adjustment programs.


* Collaborate with internal Horizon teams and external vendors on the exchange of inbound and outbound files to Risk Adjustment vendors, and conduct reconciliation and validation activities to the inbound & outbound files

* Develop and maintain data submission journal

* Perform risk adjustment analytical studies involving manipulations of large amounts of data; applying advanced programming techniques to streamline the analysis. Examples of studies include monitoring and evaluating vendor performance

* Review vendor operations reports and reconcile to Horizon data

* Analyze Risk Adjustment activity results for patterns and trends to identify opportunity to improve documentation and coding

* Support data repository for analytical studies and vendor feeds

Knowledge/Skill Sets:

* Project management skills.

* Expertise with statistical software tools in order to perform data manipulation and analysis

* Computer skills: MS Office and Access (including VBA)

* Excellent knowledge of SAS, SQL, Excel required

* Experience and knowledge of CMS regulatory requirements and communications is preferred


* BA/BS in Mathematics, Statistics, Computer Science, Actuarial Science or other strong analytical field

* Experience with manipulating large amounts of clinical and medical claims data while working in health care industry, insurance or related field.

* Knowledge of risk adjustment programs for Medicare/Medicaid, or risk mitigation programs under ACA, is a plus.

* Strong analytical skills; experience with relational database and techniques.

* Strong written and oral communication skills

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, 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.



Job Level
Individual Contributor

--Finance Data Management & Analysis

Job Type
Full Time

Newark, NJ