Enterprise Risk Adjustment Analyst III
L.A. Care Health Plan
- Los Angeles, CA
- Permanent
- Full-time
Continuously monitor and review the daily operations to identify areas of improvement and for automation process. Designs and creates processes for data extraction, summaries, and higher level analytic functions to create and use on data queries and stored procedures. Creates and maintains database for the Risk Adjustment team to improve the workflow in various operational areas of risk adjustment.Understand the end to end requirements for XML and 837 data processing channels to provide impact analyses from regulatory changes to these processes, and data reconciliation gaps.Perform other duties as assigned.Duties ContinuedEducation RequiredBachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.Education PreferredExperienceRequired:
At least 5 years of experience working in a risk adjustment role with increasing responsibilities and working with data submitted to regulatory agencies, and the return reports received from same.SkillsRequired:
Ability to consult with senior management help define business objectives and recommend analysis approach to address these objectives.Ability to provide expertise on analytic, programmatic, and process changes that is a response to changing business needs.Ability to query from various internal databases and external vendors systems in order to write/build/develop needed data to perform higher level of analytics to address business objectives. Provide recommendations to senior leadership based on analytics outcome.Knowledge of risk adjustment processes for multiple lines of business.Reporting and analytics experience of SQL Server, Visual Studio 2012, Oracle, Microsoft Access and Excel.Knowledge of MS Word, Adobe Reader, PowerPoint programs.Licenses/Certifications RequiredLicenses/Certifications PreferredRequired TrainingPhysical RequirementsLightAdditional InformationSalary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.L.A. Care offers a wide range of benefits including
- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
- Volunteer Time Off (VTO)
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