Senior Risk Adjustment Analyst

Jobtailor; Virginia (MN); On-site; USD 110,000 - 160,000; Full time

Job summary

Jobtailor seeks a data analytics professional to support regulatory submissions and risk adjustment initiatives within a health plan environment in the United States. The role emphasizes accuracy, collaboration with internal and external partners, and process improvement to reduce errors.

You will lead projects, mentor peers, and deliver metrics on HEDIS® performance and CMS interactions. Candidates should have five years in data analytics or software development, three+ years in health plans,

Qualifications

• Five years’ experience in data analytics or software development required.
• At least three years’ experience in Health Plan required.
• In depth risk adjustment and/or HEDIS® experience required.
• Expertise in Microsoft Excel and SAS/SQL is required.
• Experience in leading projects and project teams required.
• Familiarity with Medicaid risk adjustment and CMS 5-Star required.
• Familiarity with Risk Adjustment Documentation, Coding practices and NCQA quality metric experience preferred.
• Bachelor's degree in Mathematics, Statistics, Health Informatics or similar research related field required.
• Advanced degrees preferred.

Responsibilities

• Assist in accurate and comprehensive data submission to regulatory entities such as CMS
• Collaborate and coordinate with internal and external partners to minimize submission errors
• Develop and improve processes related to risk adjustment and quality improvement
• Validate data integrity and collaborate with technical teams to improve data pipelines
• Report on actionable metrics related to risk adjustment and HEDIS®
• Provide mentorship to less experienced team members

Skills

Data Analytics

Risk Adjustment

HEDIS Experience

Communication

Mentorship

Problem-Solving

Collaboration

Education

Bachelor's degree in Mathematics, Statistics, Health Informatics or similar research related field

Advanced degrees preferred

Tools

Microsoft Excel

SAS

SQL

Job description

• Assist in accurate and comprehensive data submission to regulatory entities such as CMS
• Collaborate and coordinate with internal and external partners to minimize submission errors
• Develop and improve processes related to risk adjustment and quality improvement
• Validate data integrity and collaborate with technical teams to improve data pipelines
• Report on actionable metrics related to risk adjustment and HEDIS®
• Provide mentorship to less experienced team members

Requirements

• Five years’ experience in data analytics or software development required
• At least three years’ experience in Health Plan required
• In depth risk adjustment and/or HEDIS® experience required
• Expertise in Microsoft Excel and SAS/SQL is required
• Experience in leading projects and project teams required
• Familiarity with Medicaid risk adjustment and CMS 5-Star required
• Familiarity with Risk Adjustment Documentation, Coding practices and NCQA quality metric experience preferred
• Bachelor's degree in Mathematics, Statistics, Health Informatics or similar research related field required
• Advanced degrees preferred

Core Competencies

Demonstrates expertise in data analytics and risk adjustment, with a strong focus on HEDIS® metrics and regulatory compliance. Proven ability to lead projects, mentor team members, and enhance data integrity through collaboration with technical teams.

Highest-signal resume keywords

• Data Analytics
• Risk Adjustment
• HEDIS® Experience
• Microsoft Excel
• SAS/SQL

ATS Optimization Keywords

Hard Skills

• Data Submission
• Data Validation
• Process Improvement
• Project Leadership
• Risk Adjustment Documentation
• Coding Practices
• NCQA Quality Metrics
• Statistical Analysis
• Data Pipeline Improvement
• Metrics Reporting

Soft Skills

• Collaboration
• Mentorship
• Communication
• Problem-Solving
• Coordination

Industry Keywords

• CMS
• Medicaid
• Health Plan
• Quality Improvement
• Regulatory Compliance

Tools & Technologies

• Microsoft Excel
• SAS
• SQL