Medicare Risk Adjustment Analytics Manager

4062 Aetna Resources, LLC; Washington; On-site; USD 66,000 - 146,000; Full time

Job summary

CVS Health is seeking a senior contributor for Revenue Integrity Informatics to quantify financial and risk score impacts of Medicare Advantage risk adjustment interventions. You will build and maintain analytics, datasets, and reporting pipelines in cloud environments, driving scalable solutions across informatics and actuarial teams.

The role focuses on partnering with stakeholders to implement data-driven valuation, quality control, and production processes, with opportunities to influence

Qualifications

• 5+ years of experience in healthcare analytics, data management, data engineering, reporting, or business analytics.
• 3+ years of experience writing complex SQL queries in cloud-based environments (BigQuery, Databricks, AWS).
• Experience developing and supporting automated reporting, production processes, or data pipelines.
• Experience using GitHub or other source control tools for code repositories.
• Experience with healthcare claims, enrollment, provider, diagnosis, finance, or risk adjustment data.

Responsibilities

• Develop and maintain standardized monthly program evaluation and KPI reporting using diverse data sources.
• Maintain member-level risk adjustment datasets and risk score files for Medicare Advantage/ACA programs.
• Manage cloud-based datasets and automated data pipelines in Google Cloud, Databricks, and AWS.
• Lead migration of analytic processes from SAS to cloud-based solutions.
• Monitor data quality and document processes for reproducibility.

Skills

Healthcare analytics

SQL

Cloud data

Python

Data storytelling

Education

Bachelor's degree in Analytics/Statistics/CS

Tools

BigQuery

Databricks

SAS

GitHub

Job description

CVS Health is seeking a senior contributor for Revenue Integrity Informatics to quantify financial and risk score impacts of Medicare Advantage risk adjustment interventions. You will build and maintain analytics, datasets, and reporting pipelines in cloud environments, driving scalable solutions across informatics and actuarial teams.

The role focuses on partnering with stakeholders to implement data-driven valuation, quality control, and production processes, with opportunities to influence