Systems Analyst Advisor - Commercial Risk Adjustment

Systems Analyst Advisor – Commercial Risk Adjustment

Anticipated End Date:

Location:

Hybrid (office 1‑2 days per week and virtual work). Candidates must be within a reasonable commuting distance, unless accommodation is granted as required by law.

The System Analyst Advisor supports Commercial Risk Adjustment CMS submissions and related regulatory reporting initiatives. Responsibilities include data analysis, automated data solutions, and ensuring the accuracy, integrity, and timeliness of data for CMS submissions. The role 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, the position will support the migration of legacy SQL and SAS processes to Snowflake and other cloud‑based technologies.

• 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.
• Investigate complex data issues and develop SAS and SQL solutions for regulatory reporting and business needs.
• Support User Acceptance Testing (UAT) for system enhancements, defect fixes, and 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 a related field.
• Minimum of 6 years’ experience in technologies, documenting requirements, and/or building test cases; or an equivalent combination of education and experience.

• Experience supporting Commercial Risk Adjustment CMS submissions.
• Experience with CMS Risk Adjustment processes, EDGE Server submissions, CMS regulatory reporting, and 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 with Microsoft SQL Server.
• Experience working with healthcare data, enterprise data warehouses, ETL processes, data governance, and data quality best practices.

Richmond, Roanoke, VA. Salary range: $101,120 to $151,680.

Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase plan, and 401(k) contribution (eligibility subject to requirements).