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 post-implementation of Medicare Dual Eligible Special Need Plans (D-SNP) program. Additionally, the position will support Complete Care LOB as well as developing an extensive expertise in the corporate data systems and Risk Adjustment. 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 an expertise in CMS and DMAS data and data systems
  • Develop expertise in Medicare risk adjustment  including: risk score calculation and financial risk receivable calculations
  • Develop an expertise in Risk Adjustment Processing System (RAPS) with knowledge of Encounter Data Processing System (EDPS) processes
  • Develop repeatable and ad-hoc reports related to multiple product lines and business units as assigned
  • Document applications for use in training, maintenance, and department procedures
  • Assist in the training, developing, and growth of new analysts, as well as act as project lead on requested analyses
  • Perform complex queries.  Apply extensive understanding of database tables, relations, data types and values
  • 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 


  • Knowledge of a structured query language, such as Microsoft Access, TSQL, PL/SQL, SPSS or SAS
  • Moderate analytical thinking with some demonstrated talent for identifying, scrutinizing, improving, and streamlining complex work processes
  • Performs data analysis using statistical methods
  • Able to implement solutions to complex problems
  • 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
  • Has had exposure to or experience working with Medicare and/or Medicaid data
  • Chooses appropriate tools or technology for tasks; experiments with new processes, tools, or technologies to determine applicability
  • Creates complex queries that join multiple tables / sources and significant data massaging
  • Provides opportunities for others to learn skills and concepts
  • Leads own work efforts.  Contribute suggestions to team effort; may be called upon to support multi-functional team efforts.
  • Basic understanding of how work effects the enterprise and bottom line; ability to recognize problems and propose ideas for solutions
  • Ability to interact with other functional units within the organization  such as Claims, Medical Management, Member and Network Operations, Business Development, etc.
  • Minimal coaching required
  • Able to troubleshoot most problems 


  • Required: Minimum 2-3 years of experience in data analysis and/or report development
  • Preferred: Minimum 2-3 years of experience in healthcare (preferably Medicare), business analysis or application development/implementation
  • Six Sigma Green Belt 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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