Medicare Risk Adjustment Analytics Lead

VillageCare; New York (NY); Hybrid; USD 135,000 - 152,000; Full time

Job summary

VillageCare Max is seeking a Manager of Risk Adjustment Analytics to strengthen capabilities across Medicare Advantage, Medicaid, and commercial programs. You will translate CMS methodologies and risk data into actionable insights to guide forecasting, operations, and improvement priorities.

The role requires 6-10 years in risk adjustment/healthcare analytics, with strong SAS/SQL skills, and a Bachelor’s degree (Master’s preferred).

Qualifications

• 6-10 years in risk adjustment and/or healthcare analytics.
• Deep expertise in Medicare Advantage risk adjustment, HCC modeling, and CMS methodologies.
• Proficiency with SAS, SQL, and data mining tools.
• Bachelor's degree required; Master’s preferred.

Responsibilities

• Lead risk adjustment analytics with an initial emphasis on Medicare Advantage and Medicare.
• Track risk-score movement and flag anomalies.
• Build dashboards and concise reporting for internal and external stakeholders.
• Collaborate with Performance, Finance, and data engineering teams to ensure data reliability.

Skills

Risk adjustment analytics

Healthcare analytics

Stakeholder communication

Education

Bachelor's degree

Master's preferred

Tools

SAS

SQL

Data mining tools

Job description

VillageCare Max is seeking a Manager of Risk Adjustment Analytics to strengthen capabilities across Medicare Advantage, Medicaid, and commercial programs. You will translate CMS methodologies and risk data into actionable insights to guide forecasting, operations, and improvement priorities.

The role requires 6-10 years in risk adjustment/healthcare analytics, with strong SAS/SQL skills, and a Bachelor’s degree (Master’s preferred).