Executive Leader - Medicaid Risk Adjustment Analytics

Hispanic Alliance for Career Enhancement; Kentucky; Hybrid; USD 100,000 - 231,540; Full time

Benefits offered by this job

Comprehensive benefits

Bonus program

Equity/incentive plan

Job summary

CVS Health is seeking a Lead Director for Revenue Integrity Informatics (Medicaid) to provide strategic direction and operational leadership for Medicaid risk adjustment analytics, reporting, and informatics. This senior role ensures complete, accurate revenue capture across markets and plans.

You will build scalable data pipelines, oversee risk-score reconciliation, and drive predictive analytics while coordinating with actuarial, finance, and clinical operations to ensure compliance and

Qualifications

• 10+ years of healthcare analytics and reporting in risk adjustment.
• 3+ years of leadership experience including people management.
• Advanced skills in SAS, SQL, Python or cloud analytics platforms.
• Strong knowledge of Medicaid risk models and state methods.
• Experience with data visualization tools (Tableau, Power BI, etc.).

Responsibilities

• Define and execute Medicaid risk adjustment strategy across markets and plans.
• Oversee analytics, reporting, and informatics to improve revenue accuracy and compliance.
• Lead reconciliation of risk scores and validate encounter data for state payments.
• Direct operational programs, KPIs, and analytics initiatives for performance.
• Lead a multidisciplinary team and align governance across strategy, analytics and operations.

Skills

Healthcare analytics

Leadership

SAS/SQL/Python

Regulatory knowledge

Data visualization

Education

Bachelor's degree in related field

Master's degree preferred

Tools

BigQuery

Snowflake

Databricks

Job description

CVS Health is seeking a Lead Director for Revenue Integrity Informatics (Medicaid) to provide strategic direction and operational leadership for Medicaid risk adjustment analytics, reporting, and informatics. This senior role ensures complete, accurate revenue capture across markets and plans.

You will build scalable data pipelines, oversee risk-score reconciliation, and drive predictive analytics while coordinating with actuarial, finance, and clinical operations to ensure compliance and