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Business Analyst III

Business Analyst III

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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 expertise in, Risk Adjustment Processing System (RAPS) and 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


  • 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
  • Leads analytical team. May lead multi-functional teams.
  • Ability to interact with other functional units within the organization  such as Claims, Medical Management, Member and Network Operations, Business Development, etc.
  • Ability to take ownership of relationship with vendors and provide oversight under the direction of manager.
  • Ability to communicate effectively with governmental agencies at the federal, state and local level.
  • Additional responsibilities as assigned by manager


  • Required: Minimum 3+ years of experience in data analysis and/or report development
  • Preferred: Minimum 3+ 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 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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