Senior Risk Adjustment Analytics Lead

jeffersonhealth; Philadelphia (Philadelphia County); On-site; USD 90,000 - 130,000; Full time

Job summary

Health Partners Plans, Inc. in Philadelphia seeks a Senior Risk Adjustment Analyst to drive analytics for Medicare Advantage, ACA, and risk-based programs. This role focuses on RAF analytics, coding strategy, and provider engagement across cross-functional teams.

You will support data-driven decisions, develop dashboards, and ensure compliant, audit-ready processes while collaborating with clinical and operational partners in a dynamic healthcare environment.

Qualifications

• Bachelor's Degree in Statistics, Mathematics, Economics, Data Science, Public Health, Health Informatics or equivalent experience.
• 5+ years in healthcare analytics (payer, provider, or health tech) with claims/encounters data.
• Proficiency in SQL and at least one analytics language (Python or R).
• Experience building dashboards in Power BI, Tableau, and Qlik.
• Familiarity with Medicare Advantage, Medicaid, and/or Commercial/ACA programs and risk-adjustment models (HCC, CDPS+Rx).
• Knowledge of provider coding and reimbursement (CPT, ICD-10, DRG) and managed care operations.
• Exposure to cloud data platforms (Azure/Synapse/Databricks, Snowflake, BigQuery) and modern ELT/ETL practices.
• Statistical modeling, forecasting, or predictive analytics; A/B testing and causal inference a plus.
• Experience supporting value-based care and provider engagement.

Responsibilities

• Analytics and Insight Generation: analyze utilization, cost, quantity, and outcomes to uncover drivers and opportunities.
• Risk Adjustment and Revenue Integrity: apply risk adjustment methods to monitor revenue and identify score-improvement opportunities.
• Data Engineering Lite and Data Quality: profile, reconcile, and ensure data accuracy with governance.
• Reporting and Visualization: develop dashboards and automated reports with standardized metrics.
• Stakeholder Partnership: translate complex findings for technical and non-technical audiences.
• Project Leadership and Mentorship: lead analytics projects end-to-end and mentor peers.
• Compliance, Privacy, and Security: maintain HIPAA, CMS/State regulations and audit-ready processes.
• Continuous Improvement and Automation: enhance data pipelines and explore GenAI tools for productivity.

Skills

SQL

Python

R

Data visualization

Statistical modeling

Education

Bachelor's Degree in Statistics, Mathematics, Economics, Data Science, Public Health, Health Informatics

Tools

Power BI

Tableau

Qlik

Job description

Health Partners Plans, Inc. in Philadelphia seeks a Senior Risk Adjustment Analyst to drive analytics for Medicare Advantage, ACA, and risk-based programs. This role focuses on RAF analytics, coding strategy, and provider engagement across cross-functional teams.

You will support data-driven decisions, develop dashboards, and ensure compliant, audit-ready processes while collaborating with clinical and operational partners in a dynamic healthcare environment.