Systems Analyst Advisor - Commercial Risk Adjustment

System Analyst Advisor - Commercial Risk Adjustment

Location
:
Hybrid
1. This role requires associates be in the office 1-2 days per week to foster collaboration and connectivity, while providing flexibility to support productivity and work-life balance. Alternate locations may be considered.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location will not be considered for employment unless an accommodation is granted as required by law.

The System Analyst Advisor supports Commercial Risk Adjustment CMS submissions and related regulatory reporting initiatives. This role analyzes complex data, develops automated data solutions, and ensures 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.

As part of the organization s data modernization strategy, this role will support the migration of legacy SQL and SAS processes to Snowflake and other cloud-based technologies. The ideal candidate is a proactive, self-directed professional who takes ownership of work, performs deep-dive analysis, identifies opportunities to automate and improve processes, and quickly adapts to new technologies with minimal direction.

How you will make an impact:

• 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.
• Support User Acceptance Testing (UAT) for system enhancements, defect fixes, and other initiatives impacting CMS submissions.
• Develop, maintain, and automate data extraction, validation, reporting, and reconciliation processes using SQL and SAS.
• Write, optimize, and maintain complex SQL and SAS programs and queries.
• Perform deep-dive analysis to identify trends, root causes, data quality issues, and opportunities for operational improvement.
• Support the migration of existing SQL and SAS processes, reports, and data workflows to Snowflake and other modern cloud-based technologies.
• Analyze existing code and business processes to recommend scalable, efficient solutions during modernization and migration efforts.
• 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.
• Perform data modeling and support enterprise data warehouse solutions.
• Troubleshoot production issues, implement corrective actions, and document technical processes and business rules.
• Manage multiple priorities while delivering high-quality work independently in a fast-paced environment.

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

• 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.

For candidates working in person or virtually in the below locations, the salary range for this specific position is $101,120 to $151,680

Location(s): Richmond, Roanoke, VA

In addition to salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive programs, equity stock purchase and 401k contribution. The salary offered is based on legitimate, non-discriminatory factors such as location, experience, education, and skill level, and is subject to change.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender, marital status, national…