Risk Adjustment Data Engineer (SQL, Health Plan)

Position Overview


The Senior Risk Adjustment Data Analyst will be responsible for managing Risk Adjustment data workflows at MetroPlus Health . You will also be responsible for analyzing data related to Risk Adjustment. The ideal candidate has keen analytic capabilities as well as technical skills in relational database analysis, advanced SQL coding, and ETL workflows.


You will be responsible for maintaining Enterprise Data Warehouse tables, responding to ad-hoc data requests, and managing ongoing data exchanges with external vendors. You will also serve as the technical representative for the Risk Adjustment team with various internal and external stakeholders, including the MetroPlusHealth IT department and our vendor partners.


The successful candidate is comfortable working in a SQL Server environment, including creating automated processes, ingesting data from external sources, and identifying relevant data elements from relational databases to meet reporting needs. Experience working with health care data and knowledge of standard health care data formats (i.e. 837, 834, C-CDA, FHIR) is a plus.


Scope of Role & Responsibilities

• Represent Risk Adjustment team in technical discussions with key stakeholders; translate business requirements into technical specifications.
• Establish and maintain data processes, including data exchanges with external vendor partners.
• Utilize claims, member and provider data to derive key insights, trends and answer business questions.
• Write complex SQL scripts. Develop SQL stored procedures, SSIS packages, TSQL and process modules.
• Develop test cases to validate data processes, ETL workflows, and reporting logic.
• Generate monthly extracts of claims, provider, and member data for exchange with external partners.
• Extract and transform data from Enterprise Data Warehouse to meet needs of external partners.

Required Education, Training & Professional Experience

• Bachelor's degree in information systems, Computer Science, or Database management
• Minimum 5 years of programming experience in SQL Server database object development including but not limited to stored Procedures, functions, views.
• Minimum 5 years' experience in complex healthcare data like Claims, Enrollment, Providers, and Electronic Health Record (EHR) extracts.
• Previous experience in business intelligence platforms, such as Tableau or Power BI.
• Knowledge of .Net development, Python, Javascript, JSON, XML.
• Excellent analytical and problem-solving skills
• Experience managing the application development lifecycle.
• Ability to work effectively in a team environment and adapt to different projects and assignments quickly.
• Knowledge of standard healthcare data formats, including 837, 834, C-CDA, etc.

Professional Competencies

• Integrity and Trust
• Collaboration and Time management skills
• Functional/Technical skills
• Written/Oral Communication
• Teamwork

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