Sr Risk Adjustment Analyst - Remote

Veradigm®; Chicago (IL); Remote; USD 70,000 - 110,000; Full time

Job summary

An established industry player is seeking a Sr Risk Adjustment Analyst to join their remote team. This role focuses on transforming healthcare through data-driven solutions. You will serve as a subject-matter expert in risk adjustment for Medicare Advantage and ACA, developing analytics requirements and financial projections. Collaborating with software developers and clinicians, you'll enhance product offerings and ensure compliance with CMS regulations. If you have a strong analytical background and a passion for healthcare innovation, this is a fantastic opportunity to make an impact.

Benefits

Comprehensive Benefits

Diversity and Inclusion Initiatives

Flexible Work Environment

Qualifications

• 3-5 years experience in Medicare Advantage risk adjustment analysis.
• Proficiency in SAS and SQL for data analysis and reporting.

Responsibilities

• Develop business cases for new products in risk adjustment.
• Manage customer financial improvement modeling and reporting.

Skills

Medicare Advantage Analysis

Risk Adjustment Methodology

Financial Modeling

SAS

SQL

Analytical Skills

Communication Skills

Education

Bachelor's Degree in Actuarial Science

Bachelor's Degree in Math

Bachelor's Degree in Statistics

Tools

SAS

SQL

Snowflake

Job description

Join to apply for the Sr Risk Adjustment Analyst - Remote role at Veradigm

Welcome to Veradigm, where our mission is transforming health through insightful solutions. Join our team to help address healthcare challenges faced by biopharma, health plans, providers, and patients. We focus on research, analytics, and AI to develop scalable data-driven solutions that bring value to healthcare stakeholders, aiming to transform healthcare and enable smarter care for millions.

Job Summary

The Sr Risk Adjustment Analyst serves as a subject-matter expert in Medicare Advantage, ACA, Medicaid, and ACO risk adjustment. Responsibilities include developing requirements for analytics and data products, creating financial calculations and projections, and researching customer questions regarding risk adjustment performance.

Essential Functions

1. Develop business cases and requirements for new products and enhancements, collaborating with software developers to ensure coding meets business needs.
2. Lead customer requests for ad hoc reporting or research.
3. Manage customer financial improvement modeling (e.g., Mid-Year Payment, Final Year Payment, Transfer Payment).
4. Research and monitor internal algorithm performance, recommending future improvements.
5. Collaborate with clinicians on outcomes, algorithm performance, and new product development.
6. Provide training and guidance on all aspects of risk adjustment, from data capture to CMS acceptance and audit validation.
7. Stay informed on CMS regulatory guidance and interpret impacts on products and customers.

Job Requirements

• Bachelor’s degree in Actuarial Science, Math, Statistics, or related field.
• 3-5 years of experience analyzing Medicare Advantage, ACA, or Medicaid risk adjustment data and models.
• Experience supporting scalable analytics and reporting solutions.
• Up to 10% travel may be required.

Knowledge, Skills, and Abilities

• Extensive healthcare industry experience, focusing on Risk Adjustment.
• Knowledge of MA/ACA risk scoring methodology and condition categories (HCC, RxHCC, etc.).
• Experience with actuarial or financial modeling concepts.
• Proficiency with CMS files (e.g., MMR, MOR, MAO-004, etc.) and clinical classification (diagnoses, procedures, claims).
• Experience with data submission systems (RAPS, EDPS, Edge) and filtering logic.
• Experience with MA projections and ACA transfer payments is preferred.
• Advanced knowledge of SAS, SQL; working knowledge of statistics.
• Strong analytical, technical, and problem-solving skills.
• Excellent communication and interpersonal skills.
• Self-initiative, curiosity, and ability to work in a team.
• Experience with Snowflake is a plus.

Additional Information

Veradigm promotes diversity and inclusion, offers comprehensive benefits, and values equal employment opportunity. We require applicants to be authorized to work in the US or Canada. We do not offer visa sponsorship for this position. Our policy includes COVID-19 vaccinations and adherence to CDC guidelines.