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Senior Business Analyst - Medicare Risk Adjustment

Company: Anthem, Inc.
Location: Lakeland
Posted on: January 15, 2022

Job Description:

Business Info Analyst Sr.

Location: Florida preferred. Also open to candidates in Atlanta, Indianapolis, Cincinnati, or Chicago.

Responsible for analyzing, reporting and developing recommendations on data related to complex and varied business metrics. Typically provides technical assistance to lower level staff.

Primary duties may include, but are not limited to:
Creates and maintains databases to track business performance.
Analyzes data and summarizes performance using summary statistical procedures.
Develops and analyzes business performance reports (e.g. for claims data, provider data, utilization data) and provides notations of performance deviations and anomalies.
Creates and publishes periodic reports, as well as any necessary ad hoc reports.
Validates risk score projections/financial accruals from RAPS/EDPS by weighting risk scores from V22 & V24 HCC models run.
Creates suspect list by comparing historical diagnosis data against MOR/MODD files to identify diagnosis gaps.
May make recommendations based upon data analysis
May require taking business issue and devising best way to develop appropriate diagnostic and/or tracking data that will translate business requirements into usable decision support tools.
This job is focused on complex and varied metrics, making recommendations and providing assistance to staff as compared to the Bus Info Analyst II job.

Requires a BS/BA degree in related field; 3-5 years data analysis or related experience; or any combination of education and experience, which would provide an equivalent background.
Experience with relational databases (RDMBMS) such as Microsoft SQL Server, Oracle Database, etc.
Knowledge of query tools and statistical software is required; SQL, Tableau, etc.
Ability to manipulate large sets of data is required.
Strong analytical, organizational and problem solving skills.
.NET / ASP.NET experience

Highly preferred technical skills:
Strong knowledge of Medicare and Medicaid Risk Adjustment (MRA), including technical requirements as well as challenges that health plans and providers may have in meeting reporting requirements
Understanding of applicable CMS Medicare Part C & D reporting requirements including manuals, review guides and Code of Federal Regulations
C# / VB.Net

Keywords: Anthem, Inc., Lakeland , Senior Business Analyst - Medicare Risk Adjustment, Professions , Lakeland, Florida

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