Risk Adjustment Data Engineer - New York, NY

MetroPlus Health Plan, Inc.; New York (NY); Hybrid; USD 120,000 - 160,000; Full time

Job summary

MetroPlusHealth is seeking a Risk Adjustment Data Engineer to establish and manage data processes in the Enterprise Data Warehouse, respond to ad-hoc data requests, and coordinate ongoing data exchanges with external vendors.

The ideal candidate will be comfortable in a SQL Server environment, write complex SQL, develop ETL processes with SSIS, and translate business needs into technical requirements for stakeholders. Experience with healthcare data formats (837/834/C-CDA/FHIR) is a plus.

Qualifications

• Bachelor’s degree or equivalent in Information Systems, CS, Database Management, or related field.
• 5+ years of programming in SQL Server database object development (SPs, functions, views).
• 5+ years of experience with healthcare data such as Claims, Enrollment, Providers, and EHR extracts.
• Experience with BI 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 and adapt to multiple projects quickly.
• Knowledge of standard healthcare data formats such as 837, 834, C-CDA, etc.

Responsibilities

• Represent Risk Adjustment in technical discussions; translate business requirements into technical specs.
• Monitor, maintain, and enhance data processes.
• Document workflows, data processing, and reporting logic.
• Write complex SQL scripts; develop stored procedures, SSIS, TSQL, and processing modules.
• Develop test cases to validate data processes, ETL workflows, and report logic.
• Generate monthly extracts of claims, provider, and member data for external partners.
• Extract and transform data from the EDW to meet external partner needs.

Skills

SQL Server development

T-SQL

SSIS

ETL

Healthcare data

Python

JavaScript

JSON

XML

Analytical skills

Team collaboration

Education

Bachelor's degree in Information Systems / CS / Database Management

Tools

SSIS

Tableau

Power BI

.NET development

Python

Job description

Position Overview

The Risk Adjustment Data Engineer will be responsible for establishing and managing data processes related to Risk Adjustment at MetroPlusHealth. This includes maintaining tables in the Enterprise Data Warehouse, 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. You must be able to communicate complex technical concepts to a variety of audiences, and to translate business needs into technical requirements.

The successful candidate is comfortable working in an SQL Server environment, including creating automated processes, ingesting data from external sources, and identifying relevant data elements from relational databases to meet reporting needs.

The ideal candidate will have experience working with healthcare data, including members/patient, claims, and provider tables. Knowledge of standard health care processes and 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.
• Monitor, maintain, and enhance existing data processes.
• Collaborate with team members to create comprehensive documentation of workflows, data processing, and reporting logics.
• Write complex SQL scripts. Develop SQL stored procedures, SSIS packages, TSQL and process modules.
• Develop test cases to validate data processes, ETL workflows, and report 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 required in Information Systems, Computer Science, Database Management, or a related field; or an equivalent combination of education and experience.
• 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 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
• Ability to work effectively in a team environment and adapt to different projects and assignments quickly.
• Excellent analytical and problem-solving skills

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