Senior Director, Medicaid Risk Adjustment Analytics

Hispanic Alliance for Career Enhancement; Wisconsin; Hybrid; USD 100,000 - 231,540; Full time

Job summary

CVS Health is seeking a Lead Director for Revenue Integrity Informatics (Medicaid) to provide strategic and operational leadership for Medicaid risk adjustment analytics, reporting, and informatics. You will oversee data pipelines, predictive modeling, and reconciliation to ensure accurate revenue capture across markets.

The role requires 10+ years in healthcare analytics with leadership experience and expertise in CDPS/CRG/HCC models, along with strong SQL/SAS/Python skills and experience with

Qualifications

• 10+ years of experience in healthcare analytics and reporting, risk adjustment including working knowledge with claims.
• 3+ years of leadership experience including people management, coaching, or mentoring team members.
• Advanced technical skills in SAS, SQL, Python, or cloud-based analytics platforms (e.g. BigQuery, Snowflake, Databricks).
• Expertise in state and regulatory requirements, risk adjustment methodologies, and encounter data processes.
• Strong knowledge of risk models (e.g., CDPS, CRG, HCC) and state reconciliation processes.
• Proven ability to develop and execute strategic initiatives delivering measurable business outcomes.
• Demonstrated leadership experience managing cross-functional teams and large-scale programs.
• Experience with data visualization tools (Tableau, Power BI, QuickSight, Looker).

Responsibilities

• Define and execute Medicaid risk adjustment strategy across markets and plans.
• Lead and deliver strategic initiatives to improve revenue accuracy, compliance, and performance.
• Align risk adjustment programs with state Medicaid models and methodologies.
• Represent risk adjustment informatics in executive forums to translate analytics into financial strategies.
• Oversee analytics and reporting using claims, encounters, pharmacy, and clinical data.

Skills

Healthcare analytics leadership

People management

Big data analytics

Risk adjustment knowledge

Strategic initiative execution

Cross-functional leadership

Data visualization

Education

Bachelor's degree preferred

Tools

SAS

SQL

Python

BigQuery/Snowflake/Databricks

Job description

CVS Health is seeking a Lead Director for Revenue Integrity Informatics (Medicaid) to provide strategic and operational leadership for Medicaid risk adjustment analytics, reporting, and informatics. You will oversee data pipelines, predictive modeling, and reconciliation to ensure accurate revenue capture across markets.

The role requires 10+ years in healthcare analytics with leadership experience and expertise in CDPS/CRG/HCC models, along with strong SQL/SAS/Python skills and experience with