Remote Lead: Risk Adjustment & Revenue Analytics

Lumeris Inc.; Northern (KY); Hybrid; USD 133,000 - 181,000; Full time

Benefits offered by this job

Medical, Vision and Dental plans

401k with company match

PTO & Sick Time

Job summary

Lumeris is seeking a Principal Risk Adjustment & Revenue Integrity Analytics Lead to design, build, and operationalize Medicare Advantage risk adjustment analytics. You will be the analytic truth owner, connecting risk-score performance to revenue across claims, encounters, and CMS data.

You will partner with leadership to align models with business operations, translating complex analytics into actionable insights and executive-ready narratives.

Qualifications

• Bachelor's degree in Mathematics, Statistics, Computer Science, Data Analytics, Health Informatics, Finance, or Actuarial Science.
• 8+ years of healthcare analytics experience, with Medicare Advantage Part C Risk Adjustment, RAF, CMS-HCC, and risk-adjusted payment performance.
• Experience with Risk Adjustment data flows: claims/encounters, eligibility, provider data, EDPS, MAO-004, and MMR/payment data.

Responsibilities

• Build and Own Risk Adjustment Analytic Truth for Part C/D and related dashboards.
• Forecast Part C RAF, Bid/Budget Performance, and Revenue with variance analysis.
• Reconcile Diagnosis-to-Payment lifecycle from source to payment with controls.
• Identify, size, and track recovery opportunities with clear ROI.
• Drive Risk Adjustment performance with internal teams and vendors.
• Automate recurring reporting with scalable dashboards and SQL; define business logic.
• Own domain logic and data quality criteria for executive-ready reporting.
• Communicate complex model and financial logic in clear narratives to leadership.
• Monitor CMS regulation and quantify impact on data, forecasts, and operations.

Skills

Advanced analytics

SQL proficiency

Stakeholder communication

Education

Bachelor's degree in a related field

Tools

Power BI

Tableau

SQL

Python

R

Job description

Lumeris is seeking a Principal Risk Adjustment & Revenue Integrity Analytics Lead to design, build, and operationalize Medicare Advantage risk adjustment analytics. You will be the analytic truth owner, connecting risk-score performance to revenue across claims, encounters, and CMS data.

You will partner with leadership to align models with business operations, translating complex analytics into actionable insights and executive-ready narratives.