Executive Director, Medicaid Risk Adjustment Analytics

Hispanic Alliance for Career Enhancement; Louisiana (MO); Hybrid; USD 100,000 - 231,540; Full time

Job summary

CVS Health is seeking a Lead Director - Revenue Integrity Informatics (Medicaid) to provide strategic leadership for Medicaid risk adjustment analytics, reporting, and informatics. You will drive accuracy, compliance and revenue capture while guiding cross‑functional teams and engaging executives.

Responsibilities include defining Medicaid risk adjustment strategy, building scalable data pipelines, and ensuring data integrity across encounters and state payments, with a focus on performance

Qualifications

• 10+ years of experience in healthcare analytics and reporting, risk adjustment including claims.
• 3+ years of leadership experience including people management.
• Advanced technical skills in SAS, SQL, Python, or cloud analytics platforms.

Responsibilities

• Define and execute Medicaid risk adjustment strategy across markets and plans.
• Lead development of scalable data pipelines and reporting frameworks using multiple data sources.
• Oversee health plan performance with advanced analytics and predictive modeling.
• Ensure accuracy and integrity of Medicaid encounter submissions and data.
• Lead and develop a high‑performing multidisciplinary team.

Skills

Healthcare analytics

Risk adjustment

Leadership

Cross-functional teams

Data visualization

Regulatory knowledge

Executive communication

Forecasting

Strategic initiatives

Analytics storytelling

Education

Bachelor's degree

Master's degree

Tools

SAS

SQL

Python

BigQuery

Snowflake

Databricks

Job description

CVS Health is seeking a Lead Director - Revenue Integrity Informatics (Medicaid) to provide strategic leadership for Medicaid risk adjustment analytics, reporting, and informatics. You will drive accuracy, compliance and revenue capture while guiding cross‑functional teams and engaging executives.

Responsibilities include defining Medicaid risk adjustment strategy, building scalable data pipelines, and ensuring data integrity across encounters and state payments, with a focus on performance