Systems Analyst Advisor - Commercial Risk Adjustment

Systems Analyst Advisor - Commercial Risk Adjustment

Location:

Hybrid1:
This role requires associates be in the office 1-2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered.

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.

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.

Minimum Requirements:

• Requires a 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.

Location(s):
Richmond, Roanoke, VA

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). 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.

Job Level: Non-Management Exempt