Systems Analyst Advisor - Commercial Risk Adjustment

Overview

Systems Analyst Advisor - Commercial Risk Adjustment.

Location:

Hybrid. This role supports Commercial Risk Adjustment CMS submissions and related regulatory reporting initiatives, analyzes complex data, develops automated data solutions, and ensures data accuracy, integrity, and timeliness for CMS submissions. The role also supports CMS and federal audit requests by analyzing data, responding to inquiries, validating results, and providing documentation. As part of the data modernization strategy, this role supports the migration of legacy SQL and SAS processes to Snowflake and other cloud-based technologies.

The ideal candidate is proactive, self-directed, and capable of deep-dive analysis with a focus on automation and adapting to new technologies with minimal direction.

• Support end-to-end Commercial Risk Adjustment CMS submissions, including data analysis, validation, issue resolution, submission support, and post-submission activities to ensure CMS compliance.
• Support CMS and federal audits by performing data analysis, validating results, responding to 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.
• Minimum of 6 years of experience in a variety of technologies, documenting requirements and/or building test cases; or equivalent combination of education and experience.

• 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. Hybrid schedule with in-office requirements as described in the posting.

Salary range for this position: $101,120 to $151,680. Salary is based on legitimate, non-discriminatory factors. Elevance Health offers a comprehensive benefits package, incentive programs, 401(k) match, stock purchase plan, health coverage, and additional programs subject to eligibility.

Elevance Health is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender, marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other protected status. Reasonable accommodation requests can be submitted via the Accessibility Accommodation Request Form. Various state-specific notices and fair chance information may apply where applicable.