Sr. Risk Adjustment Solutions Analyst
A
AdvantmedHealthcare analytics
United StatesFull-TimeSenior
Salary not disclosed
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Job Details
- Experience
- 5+ years of healthcare data analytics experience; 3+ years of hands-on experience in Medicare Advantage and/or ACA Risk Adjustment; 3+ years of experience as a Healthcare Data Analyst; 3+ years of advanced SQL development experience.
- Required Skills
- SQLMicrosoft SQL Server
Requirements
- Bachelor's degree in Healthcare, Statistics, Computer Science, Engineering, Business Analytics, or a related field.
- 5+ years of healthcare data analytics experience, including data mining, mapping, transformation, validation, and reporting.
- 3+ years of hands-on experience in Medicare Advantage and/or ACA Risk Adjustment.
- 3+ years of experience as a Healthcare Data Analyst.
- 3+ years of advanced SQL development experience.
- Strong understanding of Medicare Advantage and ACA Risk Adjustment programs and CMS-HCC and RxHCC models.
- Knowledge of Medical Record Review (MRR), Health Assessment processes, and the end-to-end Risk Adjustment lifecycle.
- Experience with Claims, Encounter, Eligibility, and Pharmacy data, and CMS data files including MMR and MOR.
- Advanced SQL and Microsoft SQL Server skills, including SQL Server Management Studio (SSMS).
- Experience with data mapping, reconciliation, validation, root cause analysis, data quality management, ad hoc reporting, and data extraction.
- Experience working directly with clients and executive stakeholders and managing multiple priorities independently.
- Preferred: Experience supporting Medicare Advantage health plans, provider groups, or Risk Adjustment vendors; Power BI, Tableau, financial forecasting, FHIR, EMR/EHR integrations, or healthcare interoperability standards.
Responsibilities
- Analyze Medicare Advantage and ACA Risk Adjustment program performance to identify opportunities for RAF improvement and revenue optimization.
- Provide expertise on CMS-HCC, RxHCC, Medicare Risk Adjustment methodologies, and industry best practices.
- Evaluate operational and financial performance metrics and develop data-driven recommendations.
- Support client-facing initiatives, business reviews, and executive presentations.
- Analyze, cleanse, transform, reconcile, and validate healthcare datasets from multiple sources.
- Perform analysis across Claims, Encounters, Eligibility, Pharmacy, Medical Record Review, and Health Assessment datasets.
- Conduct root cause analysis and recommend corrective actions to improve data integrity and operational performance.
- Manage CMS data sources, support reconciliation and forecasting, and develop reports, scorecards, ad hoc analyses, and executive dashboards.
- Develop, optimize, and troubleshoot SQL queries, stored procedures, and data extraction processes.
- Collaborate with business, operations, technology, and analytics teams on scalable solutions, automation, and process improvement.
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