Senior Risk Adjustment Analytics Lead — Remote

Advantmed; United States; Remote; USD 90,000 - 130,000; Full time

Benefits offered by this job

Health Plan

Annual Bonus

401k

Life Insurance

PTO

Work From Home

Wellness Resources

Job summary

Advantmed is seeking a Risk Adjustment Specialist to join our Data Analytics team in the United States. You will analyze Medicare Advantage and ACA RAF performance, translating complex data into actionable insights to drive RAF improvement and revenue optimization.

The role focuses on CMS-HCC and RxHCC methodologies, developing operational reports, and collaborating with clients, operations, technology, and leadership to support strategic decision-making and data integrity.

Qualifications

• Bachelor's degree in Healthcare, Statistics, Computer Science, Engineering, Business Analytics, or related field.
• 5+ years of healthcare data analytics experience, including data mining, mapping, transformation, validation, and reporting.
• 3+ years of hands-on experience in Medicare Advantage and/or ACA Risk Adjustment.
• 3+ years of experience as a Healthcare Data Analyst.
• 3+ years of advanced SQL development experience.

Responsibilities

• Analyze Medicare Advantage and ACA Risk Adjustment program performance to identify opportunities for RAF improvement and revenue optimization.
• Provide expertise on CMS-HCC, RxHCC, Medicare Risk Adjustment methodologies, and industry best practices.
• Evaluate operational and financial performance metrics and develop data-driven recommendations.
• Support client-facing initiatives, business reviews, and executive presentations.
• Analyze, cleanse, transform, reconcile, and validate large healthcare datasets from multiple sources.
• Perform analysis across Claims, Encounters, Eligibility, Pharmacy, MRR, and Health Assessment datasets.
• Identify trends, anomalies, and opportunities through detailed data analysis.
• Conduct root cause analysis and recommend corrective actions to improve data integrity and operational performance.

Skills

Healthcare analytics

Medicare Advantage

ACA Risk Adjustment

SQL development

Data analysis

Client engagement

Education

Bachelor's degree in Healthcare, Statistics, Computer Science, Engineering, Business Analytics, or related field

Tools

Power BI

Tableau

SQL Server

SSMS

FHIR

Job description

Advantmed is seeking a Risk Adjustment Specialist to join our Data Analytics team in the United States. You will analyze Medicare Advantage and ACA RAF performance, translating complex data into actionable insights to drive RAF improvement and revenue optimization.

The role focuses on CMS-HCC and RxHCC methodologies, developing operational reports, and collaborating with clients, operations, technology, and leadership to support strategic decision-making and data integrity.