Risk Adjustment Data Analyst II - Analytics & Insights

CommunityCare HMO Inc.; Tulsa (OK); On-site; USD 65,000 - 90,000; Full time

Job summary

CommunityCare HMO Inc. is seeking a Risk Adjustment Analyst II to support MA/ACA risk adjustment programs by managing data submissions, developing reports, and delivering actionable analytics.

You will ensure accuracy of encounter and risk score data including RAF and PLRS reporting. Responsibilities include CMS submission management, data validation, KPI dashboards, RADV support, and SQL-driven data integration across multiple data sources.

Qualifications

• Bachelor’s degree in Mathematics, Statistics, Economics, Actuarial Science or other quantitative discipline; Master’s preferred.
• Analytical tools such as SAS or SQL used.
• Power BI, Tableau or similar visualization tools preferred.
• Minimum three years of health data analysis; two+ years risk adjustment preferred.

Responsibilities

• Manage CMS encounter submissions and ACA data processes including EDGE/PLRS reporting.
• Perform data validation, reconciliation, and root cause analysis to resolve variances.
• Analyze submission errors and rejection trends to improve quality.
• Develop risk score reporting and KPIs/dashboards (RAF/PLRS, enrollment, trends).
• Prepare monthly production and performance reports across retrieval, coding, and vendor ops.
• Support RADV activities and chase list development.
• Write complex SQL queries across claims, encounters, enrollment, pharmacy, and vendors.
• Partner with vendors and internal teams to improve data quality and reporting.
• Analyze CMS response files (MAO-004) and MMR for trends and opportunities.
• Mentor junior analysts and promote best practices.

Skills

Advanced analytics

Independent work management

Data visualization

SQL queries

Healthcare data

Communication skills

Education

Bachelor’s degree in Mathematics/Statistics/Economics/Actuarial Science

Master’s degree preferred

Tools

SQL

Power BI

Tableau

Excel

Job description

CommunityCare HMO Inc. is seeking a Risk Adjustment Analyst II to support MA/ACA risk adjustment programs by managing data submissions, developing reports, and delivering actionable analytics.

You will ensure accuracy of encounter and risk score data including RAF and PLRS reporting. Responsibilities include CMS submission management, data validation, KPI dashboards, RADV support, and SQL-driven data integration across multiple data sources.