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Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware
Job Summary:
The Risk Adjustment Vendor & Performance Analyst is responsible for supporting the management and administration of risk adjustment vendors and performance monitoring of those vendors and the overall risk adjustment department. This includes managing all data transferred to and from Risk Adjustment vendors as well as other external and internal areas related to establishing and maintaining operations with a vendor. The analyst will support contracting of vendors with data and financial analysis, and support detailed invoice processing and reconciliation, and the establishment and ongoing monitoring of key vendor performance metrics after implementation. It will be the analyst's responsibility to identify trends or problems and make recommendations to leadership. The Risk Adjustment Analyst, Vendor & Performance will contribute to the annual budget process and provide detailed vendor forecasts as well as monthly data for accounting teams. The analyst will also perform the same performance monitoring of internal risk adjustment teams performing regular operations providing similar analysis to leadership.- Perform data analysis to assess the quality of incoming and outgoing data to and from risk adjustment vendors ; establish metrics, identify trends and make recommendations.
- Research, analyze, validate, and prepare data across multiple system platforms and sources for use in monitoring and reporting.
- Support vendor contract negotiations through cost analysis, ROI estimation, and budget forecasting.
- Establish vendor and department performance metrics and measure on an ongoing basis providing insights and recommendations to leadership.
- Review data and develop recommendations for new approaches and/or process improvement opportunities; identify impact of business processes on other departments and/or stakeholders.
- Analyze data flow and data integrity to identify areas for improvement.
- Measure vendor performance and other expectations as per the contract and enterprise requirements.
- Calculates and assesses financial penalties based on contractual performance.
- Serve as the centralized resource for information on vendor cost, services, contract terms, quality, and performance.
- Review and validate invoice submissions to ensure alignment with contractual agreements.[
- Ensure appropriate documentation and tracking of vendor information for multiple purposes including audits, quality indicators, service scope, contract renewal, and cost-efficiency.
- Assist with contract negotiation, analyzes contractual requirements, identifies contract deficiencies and recommend changes.
- Reports results to applicable committees within the organization.
- Transfer data into meaningful and easy to understand dashboards.
- Communicate internally and externally as needed to gather necessary data.
Education/Experience:
- Requires a Bachelors' degree from an accredited college or university in Mathematics, Statistics, Economics, Accounting, Finance, Actuarial Science or other strong analytical field
- Masters' degree in business, finance, or statistics or other related field preferred.
- CPA, CMA, ASA, or FSA preferred.
- Requires a minimum of4 years with hands on experience with predictive analytics, data and reporting, performance monitoring, or vendor evaluation in a technical or other financial capacity
- Clinical and medical claims data and disease diagnostic coding practice a plus
- Experience with manipulating large amounts of clinical and medical claims data while working in health care industry, insurance or related field is preferred
Knowledge, Skills and Abilities:
- Experience with data visualization and presentation, turning complex analysis into insight.
- Expertise with statistical software tools in order to perform data manipulation and analysis
- 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.
- Project management skills.
- Excellent knowledge of SAS, SQL, and Excel is a must.
- Computer skills: Excel (including pivot tables), Access (including VBA), SAS (preferred)
Travel % (If Applicable):
- Occasional travel to Newark - Penn Plaza office
Salary Range:
$84,700 - $115,605This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, 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 known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:
Comprehensive health benefits (Medical/Dental/Vision)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
Paid Volunteer Time Off
Tuition Reimbursement
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. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.