Risk Adjustment Data Analyst II: Insight MA/ACA Analytics

CommunityCare, Inc.; Tulsa (OK); On-site; USD 90,000 - 110,000; Full time

Job summary

CommunityCare, Inc. in Tulsa is seeking a Risk Adjustment Analyst II to manage data submissions for MA/ACA programs and deliver actionable analytics. You will ensure accuracy of encounter data, RAF and PLRS reporting, and develop dashboards to monitor enrollment and risk trends.

The role requires strong SQL skills, experience with SAS/BI tools, and the ability to mentor junior analysts while partnering with vendors to improve data quality. This is an on-site position in Oklahoma.

Qualifications

• Bachelor’s degree in mathematics, statistics, economics, actuarial science or other quantitative discipline.
• Demonstrated use of analytical tools such as SAS or SQL.
• Experience with Power BI, Tableau, or other visualization tools preferred.
• Three years of health data analysis experience; risk adjustment experience preferred.

Responsibilities

• Manage CMS encounter submissions and ACA data processes including EDGE/PLRS reporting.
• Perform data validation, reconciliation, and root cause analysis to identify variances.
• Analyze submission errors and rejection trends to improve data quality.
• Develop and maintain risk score reporting, KPIs and dashboards (RAF, PLRS, enrollment).
• Prepare monthly production and performance reports across retrieval, coding, and vendor operations.
• Support RADV activities and chase list development.
• Write complex SQL queries and integrate data across claims, encounters, enrollment, pharmacy, and vendor sources.
• Mentor and support junior analysts to promote best practices.
• Translate data into actionable business insights and recommend process improvements.
• Serve as a subject matter resource for risk adjustment data and reporting.

Skills

SQL

Data analysis

Risk adjustment

EDGE/PLRS

Power BI

Tableau

Data governance

Communication

Education

Bachelor’s degree in quantitative field

Master’s degree preferred

SAS certification or equivalent

Tools

SAS

Power BI

Tableau

Job description

CommunityCare, Inc. in Tulsa is seeking a Risk Adjustment Analyst II to manage data submissions for MA/ACA programs and deliver actionable analytics. You will ensure accuracy of encounter data, RAF and PLRS reporting, and develop dashboards to monitor enrollment and risk trends.

The role requires strong SQL skills, experience with SAS/BI tools, and the ability to mentor junior analysts while partnering with vendors to improve data quality. This is an on-site position in Oklahoma.