Risk Adjustment Data Analyst: RAF & HCC Insights

ArchWell Health; Oregon; Hybrid; USD 90,000 - 120,000; Full time

Job summary

ArchWell Health seeks a Risk Adjustment Data Analyst to support end-to-end risk adjustment and revenue cycle operations. You will analyze HCC submissions, monitor 277CA/999 files, and drive reconciliation across MA programs.

The role involves chart retrieval, data ingestion, and cross-functional collaboration with Operations, Coding, and IT teams. Qualified candidates have 3–5 years in risk adjustment or payer operations, strong SQL/Excel skills, and experience with HCC mapping and RAF models.

Qualifications

• Bachelor's degree in Healthcare Administration, Data Analytics, Public Health, or related field.
• 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.
• Proficient in SQL, Excel and data visualization tools (Power BI, Tableau).
• Ability to interpret clinical documentation and coding outputs (ICD-10, HCC mapping).
• Strong analytical, problem-solving and communication skills.
• Experience with chart-retrieval vendors or clinical documentation teams preferred.

Responsibilities

• HCC reconciliation, validation of submissions, and routing rejections.
• Review sweeps datasets and monitor payer acceptance trends.
• Manage chart retrieval and ensure proper linkage to members and HCCs.
• Ingest and analyze health plan care-gap files; map into internal systems.
• Build dashboards and reports tracking HCC operations, productivity, and bottlenecks.
• Collaborate with Operations, RCM, Coding, and IT/Data teams; governance participation.

Skills

Risk adjustment

RCM

Healthcare analytics

Payer operations

HCC models

RAF knowledge

MAO004 familiarity

277CA familiarity

Submission workflows

SQL

Excel

Power BI

Tableau

ICD-10 interpretation

HCC mapping

Analytical thinking

Problem solving

Communication

Chart retrieval vendor work

Education

Bachelor's degree in Healthcare Administration

Data Analytics

Public Health or related field

Tools

SQL

Excel

Power BI

Tableau

Job description

ArchWell Health seeks a Risk Adjustment Data Analyst to support end-to-end risk adjustment and revenue cycle operations. You will analyze HCC submissions, monitor 277CA/999 files, and drive reconciliation across MA programs.

The role involves chart retrieval, data ingestion, and cross-functional collaboration with Operations, Coding, and IT teams. Qualified candidates have 3–5 years in risk adjustment or payer operations, strong SQL/Excel skills, and experience with HCC mapping and RAF models.