Systems Analyst Advisor - Commercial Risk Adjustment

About the role

The System Analyst Advisor supports Commercial Risk Adjustment CMS submissions and related regulatory reporting initiatives. This role is responsible for analyzing complex data, developing automated data solutions, and ensuring the accuracy, integrity, and timeliness of data used for CMS submissions. The position also supports CMS and federal audit requests by analyzing data, responding to CMS inquiries, validating results, and providing documentation to meet regulatory requirements.

Responsibilities

• Support end-to-end Commercial Risk Adjustment CMS submissions, including data analysis, validation, issue resolution, submission support, and post-submission activities to ensure compliance with CMS requirements.
• Support CMS and federal audits by performing data analysis, validating results, responding to CMS inquiries, and providing required documentation.
• Independently investigate complex data issues and develop SAS and SQL solutions to support regulatory reporting and business needs.
• Write, optimize, and maintain complex SQL and SAS programs and queries.
• Develop, maintain, and automate data extraction, validation, reporting, and reconciliation processes using SQL and SAS.
• Partner with business and IT teams to evaluate system changes, assess impacts to CMS submissions, and implement effective solutions.
• Proactively identify opportunities to automate manual processes, improve data quality, and increase operational efficiency.
• Manage multiple priorities while delivering high-quality work independently in a fast-paced environment.

Requirements

• Requires an BA/BS degree in Information Technology, Computer Science or related field of study and a minimum of 6 years experience in a variety of technologies, documenting requirements and/or building test cases; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, And Experiences

• Experience supporting Commercial Risk Adjustment CMS submissions; Commercial Risk Adjustment experience is highly preferred.
• Experience with CMS Risk Adjustment processes, EDGE Server submissions, CMS regulatory reporting, and/or federal audits.
• Experience responding to CMS inquiries and supporting regulatory compliance activities.
• Experience migrating SQL, SAS, or ETL processes to Snowflake, Python, Spark/Snowpark and cloud-based data warehouse technologies.
• Experience migrating SQL, SAS, or reporting solutions to Snowflake or similar cloud platforms.
• Experience with Microsoft SQL Server.
• Experience working with healthcare data, enterprise data warehouses, ETL processes, data governance, and data quality best practices.

Benefits

Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and a 401(k) match. Additional benefits include medical, dental, vision, short and long term disability benefits, life insurance, wellness programs, and financial education resources. The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.