Sr Risk Adjustment Analyst - Remote

Veradigm®; Houston (TX); Remote; USD 70,000 - 110,000; Full time

Job summary

An established industry player is seeking a Sr Healthcare Risk Adjustment Analyst to leverage their expertise in Medicare Advantage and Medicaid Risk Adjustment. This remote role involves developing analytics requirements, managing financial modeling, and collaborating with clinicians to enhance product offerings. The ideal candidate will have a strong background in data analysis, particularly in healthcare, and will play a key role in driving improvements in risk adjustment processes. Join a company that values professional development and promotes diversity while making a significant impact in the healthcare sector.

Benefits

Comprehensive benefits package

Professional development opportunities

Diversity and equal employment opportunities

Qualifications

• 3-5 years of experience analyzing Medicare Advantage and Medicaid data.
• Proficiency in SAS and SQL for data analysis and reporting.

Responsibilities

• Develop business cases and requirements for new analytics products.
• Manage customer financial improvement modeling and reporting.

Skills

Medicare Advantage Analysis

Risk Adjustment Data Analysis

SAS

SQL

Analytical Skills

Communication Skills

Problem-Solving Skills

Education

Bachelor’s degree in Actuarial Science

Bachelor’s degree in Math

Bachelor’s degree in Statistics

Tools

SAS

SQL

Snowflake

Job description

Sr Healthcare Risk Adjustment Analyst - Remote

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

Job Summary

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

Essential Functions

1. Develop business cases and requirements for new and existing products, coordinating 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 enhancements.
5. Collaborate with clinicians on outcomes, algorithm performance, and new product development.
6. Provide training and guidance on the Risk Adjustment process, from data capture to CMS validation.
7. Stay informed on CMS regulatory guidance and interpret impacts to products and clients.

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.
• Familiarity with MA/ACA Risk Scoring methodology and condition categories (HCC, RxHCC, etc.).
• Experience with actuarial/financial modeling concepts.
• Proficiency with CMS files (MMR, MOR, MAO-004, etc.) and clinical data (ICD, CPT, HCPCS).
• Experience with data submission systems (RAPS, EDPS, Edge) and filtering logic.
• Knowledge of MA mid-year/final projections and ACA transfer payments is preferred.
• Proficiency in SAS and SQL; knowledge of statistics and interest in further learning.
• 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 supports professional development and offers a comprehensive benefits package. We promote diversity and equal employment opportunities and require all associates to be vaccinated against COVID-19 per CDC guidelines. Visa sponsorship is not available for this role.