Medicaid Risk Adjustment Analytics Leader

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

Benefits offered by this job

Medical insurance

Dental insurance

Retirement plan

Job summary

CVS Health is seeking a Lead Director for Revenue Integrity Informatics (Medicaid) to provide strategic leadership over Medicaid risk adjustment analytics, reporting, and informatics. This senior role drives data‑driven revenue capture, aligns with state models, and partners with finance and actuarial teams to ensure accuracy and compliance.

The position leads a multidisciplinary team, develops scalable data pipelines, and communicates insights to executives.

Qualifications

• 10+ years of experience in healthcare analytics and reporting, risk adjustment including relevant working knowledge with claims.
• 3+ years of leadership experience including people managing, coaching, or mentoring team members.
• Advanced technical skills in SAS, SQL, Python, or cloud‑based analytics platforms (e.g. BigQuery, Snowflake, Databricks).
• Expertise in state and regulatory requirements, risk adjustment methodologies, and encounter data processes.
• Strong knowledge of risk models (e.g., CDPS, CRG, HCC) and state reconciliation processes.
• Proven ability to develop and execute strategic initiatives that deliver measurable business outcomes.
• Demonstrated leadership experience managing cross‑functional teams and large‑scale programs.
• Experience with data visualization tools (e.g. Tableau, Power BI, QuickSight, Looker, etc.).

Responsibilities

• Define and execute Medicaid risk adjustment strategy across markets and plans.
• Lead and deliver high‑impact strategic initiatives that improve revenue accuracy, compliance, and overall performance.
• Align risk adjustment programs with state Medicaid models and methodologies.
• Represent risk adjustment Medicaid informatics in executive forums to drive alignment on strategic goals and translate analytics into actionable insights.

Skills

Healthcare analytics

Leadership

SAS

SQL

Python

Cloud analytics platforms

Risk adjustment knowledge

Data visualization (Tableau/Power BI)

Education

Bachelor's degree

Tools

SAS

SQL

Python

BigQuery

Snowflake

Databricks

Tableau

Power BI

Looker

QuickSight

Job description

CVS Health is seeking a Lead Director for Revenue Integrity Informatics (Medicaid) to provide strategic leadership over Medicaid risk adjustment analytics, reporting, and informatics. This senior role drives data‑driven revenue capture, aligns with state models, and partners with finance and actuarial teams to ensure accuracy and compliance.

The position leads a multidisciplinary team, develops scalable data pipelines, and communicates insights to executives.