Virginia Premier Health Plan, Inc.

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Business Analyst II

Business Analyst II

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Job Description


This position is responsible for assisting in the implementation and operations of analysis supporting the Medicare Advantage Prescription Drug (MAPD) program. Responsibilities include gathering requirements; performing analysis; supporting the development and testing of processes; and understanding and documenting the applications, data, and associated technologies for supported areas.


  • Develop expertise in CMS data, data systems, and MAPD regulations
  • Develop expertise in Medicare risk adjustment including Risk Adjustment Processing System (RAPS), risk score calculation, and financial risk receivable calculations
  • Design, develop, and create ad-hoc and recurring reports integrating data from multiple systems to support MAPD revenue optimization, risk management, and business units as assigned
  • Collaborate with internal business units and business intelligence teams to define and deliver MAPD reporting and analytics needs
  • Document applications, data organizational structures, testing procedures, and reporting deliverables for use in training, maintenance, and department procedures
  • Assist in the training and development of new analysts, as well as act as project lead on requested analyses
  • Assist in development of benchmark reports
  • Assist in the analysis and presentation of business opportunities



Bachelors Degree in Business, Health Administration, Mathematics, Information Systems, or related field



  • Highly analytical thinking with demonstrated talent for identifying, scrutinizing, improving, and streamlining complex work processes
  • Highly skilled in writing queries that join multiple data sources and complex data manipulation, using such tools as Microsoft Access, TSQL, PL/SQL, SPSS, or SAS
  • Has experience working with Medicare and/or Medicaid data
  • Demonstrates an active interest in enhancing current skills and learning new ones; applies advanced functional or technical knowledge to do his or her job at a high level of accomplishment
  • Consistently shares expertise with others, teaching/coaching skills, and explaining concepts
  • Ability to interact with other functional units within the organization such as Claims, Medical Management, Member Operations, Network Development, Business Development, etc.
  • Additional responsibilities as assigned by manager


  • Required: Minimum 2+ years of experience in data analysis and/or report development
  • Preferred: Minimum 2+ years of experience in healthcare (preferably Medicare), business analysis or application development/implementation
  • Prior experience with encounter data submission a major plus
  • Six Sigma Green Belt preferred
  • Working knowledge of Tableau preferred


Physical health sufficient to meet the ergonomic standards and demands of the position.


About Us

Virginia Premier Health Plan, Inc. is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs.  Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia. 


We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.  


All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE


Our mission is to inspire healthy living within the communities we serve!

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