Remote Senior Risk Adjustment Analytics Lead

Advantmed; Northern (KY); A distancia; USD 90.000 - 140.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Health Care Plan (Medical, Dental &amp

Annual Performance Bonus

401k, IRA Retirement Plan

Life Insurance

Paid Time Off

Family Leave

Disability

Work From Home

Wellness Resources

Descripción de la vacante

Advantmed is seeking a seasoned Risk Adjustment Specialist to lead analytics initiatives, translating CMS data and RAF performance into actionable business insights for health plans and providers.

The role emphasizes Medicare Advantage, ACA Risk Adjustment, and strong SQL development, with collaboration across clients, operations, technology, and leadership to drive performance and strategic decisions.

Formación

• 5+ years in healthcare data analytics including data mining, mapping, transformation.
• 3+ years hands-on Medicare Advantage and/or ACA Risk Adjustment.
• 3+ years as a Healthcare Data Analyst.
• 3+ years advanced SQL development.
• Experience with CMS data files (MMR, MOR) is a plus.

Responsabilidades

• Analyze Medicare Advantage and ACA RAF performance to identify opportunities for RAF improvement and revenue optimization.
• Provide expertise on CMS-HCC, RxHCC, Medicare Risk Adjustment methodologies, and industry best practices.
• Evaluate operational and financial performance metrics and develop data-driven recommendations.
• Support client-facing initiatives, business reviews, and executive presentations.

Conocimientos

Healthcare analytics

SQL development

Client-facing

Data analysis

Educación

Bachelor's degree in Healthcare, Statistics, CS, Engineering, Business Analytics, or related field

Herramientas

Power BI

Tableau

SSMS

SQL Server

Descripción del empleo

Advantmed is seeking a seasoned Risk Adjustment Specialist to lead analytics initiatives, translating CMS data and RAF performance into actionable business insights for health plans and providers.

The role emphasizes Medicare Advantage, ACA Risk Adjustment, and strong SQL development, with collaboration across clients, operations, technology, and leadership to drive performance and strategic decisions.