10 days old

Lead Govt Markets Program Analyst (ACA)

Independence Blue Cross LLC
Philadelphia, PA 19107
  • Job Code
    191476

Independence Blue Cross is a company in motion, continually refining our processes and products to offer the best value to our more than 3.5 million members. With our subsidiaries, we employ nearly 10,000 people. As a pacesetter in our dynamic industry, Independence Blue Cross is not only a leader, but also an experienced innovator growing and expanding into new markets in ways that logically maximize our opportunities and success.


Government Markets is hiring a Lead Program Analyst to join its Commercial Risk Analytics Team. This professional will be responsible for analyzing risk profiles for both IBC & Amerihealth New Jersey ACA products to assess risk, opportunities and potential impacts to reimbursement level for our Commercial risk adjustment programs. Using tools including SQL Server and Tableau, the Lead Program Analyst will develop clear business specifications, troubleshoot and recommend solutions to improve Risk Adjustment Scores for the Commercial Risk Analytics Team. Must have strong organizational, analytical, problem solving and decision-making skills. Ability to persuade, negotiate and resolve issues. Needs to be self-motivated, highly organized and detail oriented. Ability to define complex business issues and determine "best fit" solutions.



Required Experience:

Bachelors Degree in Business, Finance or Information Systems/Science (or equivalent work experience)
7+ years of relevant more experience
Experience in program or project management with the ability to ensure adherence to budget, schedule, and scope
Experience gathering, analyzing large datasets and presenting into business intelligence
Demonstrated experience with Tableau or other data visualization software programs preferred
Experience in Budgeting, FRPs & RFQs
Knowledge of SQL programing skills with emphasis in large datasets
Working experience Microsoft applications (PowerPoint, Excel and Visio)
Experience dealing with internal and external customers
Excellent oral/written communication skills required Specific duties:
Design, implement, and manage ACA prospective & retrospective programs (both internal & vendor based)
Work with management in establishing operational goals and defining benchmarks metrics for Commercial Risk Adjustment Programs
Evaluate the effectiveness of programs and provide regular summary of programs status and enhancement options
Translate operational metrics into business results and forecasts
Oversee annual HHS Risk Adjustment Data Validation (RADV) audit including managing vendor activity and ensuring compliance with CMS regulations
Statistical Analysis/benchmarking, RADV Error Rate forecasting
Keep informed of regulations impacting the ACA as it relates to Risk Adjustment
Work with internal and external customers to resolve issues
Own provider and vendor payment process
Oversee program operating budgets and support related finance / billing functions
Ensure timely contract renewals and RFP process when necessary
Responsible for provider and member communications from draft, approval to distribution
Perform specific duties of the Lead Program Analyst as required







Posted: 2019-11-25 Expires: 2019-12-24
Sponsored by:
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Sponsored by:
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Lead Govt Markets Program Analyst (ACA)

Independence Blue Cross LLC
Philadelphia, PA 19107

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