Senior Risk Adjustment & Revenue Analytics Lead (Remote)

Lumeris Inc.; United States; Remote; USD 133,000 - 181,000; Full time

Benefits offered by this job

Medical, Vision and Dental Plans

401k with company match

Paid Time Off

Job summary

Lumeris Inc. is seeking a Principal Risk Adjustment & Revenue Integrity Analytics Lead to design, build, validate, and operationalize Medicare Advantage analytics.

You will own the analytics assets, harmonize data from claims, encounters, and CMS sources, and translate findings into actionable business insights for executive leadership. You will partner with the VP and Senior Director to align analytic models with business operations, drive proactive risk/revenue intelligence, and scale

Qualifications

• Bachelor's degree in Mathematics, Statistics, CS, Data Analytics, Health Informatics, Finance or Actuarial Science.
• 8+ years in healthcare analytics with Medicare Advantage risk adjustment experience.
• Experience with RAF, CMS-HCC, and risk-adjusted payment performance.
• Experience with risk adjustment data flows and model validation.
• Ability to forecast and reconcile performance across bids, budgets and actuals.
• Proficient in SQL and dashboarding tools (Power BI/Tableau).
• Strong communication to senior leadership.

Responsibilities

• Build and own risk adjustment analytic truth: dashboards and reporting for Part C/D.
• Forecast RAF, Bid/Budget, and revenue; analyze variances with documented drivers.
• Trace diagnosis-to-payment lifecycle to create reconciliation controls.
• Identify, size, and track recovery opportunities with ROI clarity.
• Drive risk adjustment performance with internal teams and stakeholders.
• Automate recurring reporting with scalable dashboards and SQL assets.
• Own domain business logic and data quality criteria for trustworthiness.
• Translate complex analytics into executive narratives for leadership.
• Monitor CMS regulation and quantify its impact on data and forecasts.

Skills

Risk Adjustment

Forecasting

SQL

Dashboarding

Data validation

QA controls

AI analytics

Communication

Modeling

Leadership

Education

Bachelor's degree in a related field

Advanced degree preferred

Tools

Power BI

Tableau

Job description

Lumeris Inc. is seeking a Principal Risk Adjustment & Revenue Integrity Analytics Lead to design, build, validate, and operationalize Medicare Advantage analytics.

You will own the analytics assets, harmonize data from claims, encounters, and CMS sources, and translate findings into actionable business insights for executive leadership. You will partner with the VP and Senior Director to align analytic models with business operations, drive proactive risk/revenue intelligence, and scale