Sql Data Analyst (Risk Adjustment)

Network Health’s success is rooted in its mission to create healthy and strong Wisconsin communities. It drives the decisions we make, including the people we choose to join our growing team. Network Health is seeking a Risk AdjustmentData Analyst. This individual is responsible for supporting the critical data functions for the Risk Adjustment Department.  Performs analysis, design, coding, testing, and maintenance of data imports and extracts while remaining compliant with all Center for Medicare and Medicaid Services (CMS) and Health and Human Services (HHS) laws, guidance, regulations and standards.  Takes part in the detection and correction of data errors.  Responsible for standard monthly reporting, ad hoc requests, as well as the development, coding and testing of new reports.  Participates in internal and external data audit activities.  Responsible for the ongoing maintenance and enhancements for the Risk Adjustment coding tool.  Provides analytical support on various strategies to ensure organizational goals are met.  

Job Responsibilities:

• Develop, test, run and maintain monthly, quarterly, and annual Risk Adjustment reports and conduct or participate in department audits.
• Create and submit supplemental data files for Medicare Advantage and ACA-qualified lines of business.
• Coordinate the maintenance and enhancements for the Risk Adjustment coding tool.
• Provide data analytics and reporting support for internal and external audits.
• Organize and manage vendor reports.
• Participate in the data error identification effort and coordinate error resolutions with key stakeholders in the company (i.e. claims, enrollment, pharmacy, etc.).
• Develop policies, procedures and other documentation related to Risk Adjustment processes.
• Propose innovative approaches to create or improve automation and optimize processes.
• Other duties as assigned. 

Job Requirements:

• Bachelor’s Degree in Information Technology, Health Care Information or similar field required or equivalent years of experience may be substituted.
• 3+ years working in a health insurance or government programs role required.
• 2+ years’ experience working as a Business Analyst or similar role required.
• Experience working with SQL required.
• Prior Risk Adjustment experience strongly preferred. This includes working with CMS/HHS file submissions, 837 and 834 file submissions and health plan data including provider or claims processing systems. 

*WARNING: Please beware of phishing scams that promote work-at-home opportunities and which may also pose as legitimate companies. Please be advised that Network Health recruiter will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for a role with our company. All of our positions require that you first complete an online application.