Systems Analyst Advisor - Commercial Risk Adjustment

• 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.

• Requires an 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.

• 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.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact View email address on aplitrak.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act