Risk Adjustment Data Analyst: RAF & HCC Analytics

ArchWell Health; United States; On-site; USD 85,000 - 120,000; Full time

Job summary

ArchWell Health is seeking a Risk Adjustment Data Analyst to support end-to-end risk adjustment and revenue cycle operations. You will analyze HCC submissions, manage chart retrieval and review workflows, and ensure accurate data ingestion for RAF accuracy across MA programs.

Flexibility to adapt as risk adjustment needs evolve across markets and programs. The role requires strong SQL, Excel, and data visualization skills, with experience in chart retrieval vendors and clinical data mapping.

Qualifications

• Bachelor's degree in a healthcare/ analytics field is required.
• 3–5 years of experience in risk adjustment, RCM, healthcare analytics, or payer operations.
• Strong understanding of HCC models, RAF, MAO004, 277CA/999/835 files, and encounter submission workflows.
• Proficiency with SQL, Excel, and data visualization tools (Power BI, Tableau).
• Ability to interpret clinical documentation and coding outputs (ICD10, HCC mapping).
• Strong analytical, problem solving, and communication skills.

Responsibilities

• Perform monthly validation of all HCC submissions (MAO004, encounters, claims, sweeps).
• Analyze payer acceptance, rejections, and 277CA/999 acknowledgement files.
• Identify new, recaptured, and dismissed HCCs and reconcile against internal systems (VIM, HCC engine).
• Present and route any rejections/gaps for appropriate teams.

Skills

SQL

Excel

Power BI

Tableau

Education

Bachelor's degree in Healthcare Administration, Data Analytics, Public Health, or related field

Tools

VIM

Job description

ArchWell Health is seeking a Risk Adjustment Data Analyst to support end-to-end risk adjustment and revenue cycle operations. You will analyze HCC submissions, manage chart retrieval and review workflows, and ensure accurate data ingestion for RAF accuracy across MA programs.

Flexibility to adapt as risk adjustment needs evolve across markets and programs. The role requires strong SQL, Excel, and data visualization skills, with experience in chart retrieval vendors and clinical data mapping.