Impactful Risk Adjustment Data Analyst II | SQL & BI

Communitycare; Tulsa (OK); On-site; USD 65,000 - 95,000; Full time

Job summary

Communitycare seeks an experienced Risk Adjustment Analyst II to support Medicare Advantage and ACA risk adjustment programs. You will manage CMS encounter submissions, develop reporting and dashboards, and deliver actionable analytics to ensure data accuracy and program success.

The role involves SQL querying, data validation, and cross-functional collaboration with vendors to improve data quality and operational performance.

Qualifications

• Bachelor's degree in Mathematics, Statistics, Economics, Actuarial Science or other quantitative discipline required.
• Minimum of three years of Health Data analysis experience; two+ years in risk adjustment preferred.
• Demonstrated use of analytical tools such as SAS or SQL.
• Experience with Power BI, Tableau, or other visualization tools preferred.
• Strong analytical, critical thinking, and problem solving skills.

Responsibilities

• Manage CMS encounter submissions and ACA data processes including EDGE/PLRS reporting.
• Perform data validation, reconciliation, and root cause analysis to identify variances.
• Analyze submission errors, response files, and rejection trends to improve data quality.
• Develop and maintain risk score reporting and KPIs like RAF and PLRS.
• Prepare monthly production and performance reports across retrieval, coding, and vendor operations.
• Support RADV activities including chase list development.
• Write complex SQL queries across claims, encounters, enrollment, pharmacy, and vendor sources.
• Mentor junior analysts to promote consistency and best practices.
• Translate data into actionable business insights and serve as SME for risk adjustment reporting.

Skills

Statistical analysis

SQL querying

Data validation

Communication

Mentoring

Problem solving

Education

Bachelor’s degree in quantitative field

Master’s degree a plus

Tools

SAS

SQL

Power BI

Tableau

Job description

Communitycare seeks an experienced Risk Adjustment Analyst II to support Medicare Advantage and ACA risk adjustment programs. You will manage CMS encounter submissions, develop reporting and dashboards, and deliver actionable analytics to ensure data accuracy and program success.

The role involves SQL querying, data validation, and cross-functional collaboration with vendors to improve data quality and operational performance.