Sr Risk Adjustment Analyst - Remote

Veradigm®; Raleigh (NC); Remote; USD 70,000 - 110,000; Full time

Job summary

Join a forward-thinking company as a Sr Risk Adjustment Analyst, where you will leverage your expertise in Medicare Advantage and Risk Adjustment to develop impactful analytics and data products. This role involves collaborating with software developers, managing financial modeling, and providing training on risk adjustment processes. You will be instrumental in transforming healthcare by ensuring compliance with CMS regulations and improving algorithm performance. If you're passionate about healthcare analytics and eager to make a difference, this opportunity is for you!

Benefits

Comprehensive benefits

Holidays

Vacation

Insurance

Retirement plans

Qualifications

• 3-5 years of experience in analyzing Medicare Advantage, ACA, or Medicaid data.
• Extensive healthcare industry experience focusing on Risk Adjustment.

Responsibilities

• Develop business cases and requirements for risk adjustment products.
• Manage customer financial modeling and research algorithm performance.

Skills

Medicare Advantage Analysis

Risk Adjustment Methodology

Financial Modeling

SAS

SQL

Data Analysis

Problem-Solving

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 leveraging research, analytics, and AI to develop scalable, data-driven solutions that add value across healthcare stakeholders. Together, we can transform healthcare and enable smarter care for millions.

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 analytics and data products, creating financial calculations and projections, and researching customer questions related to risk adjustment performance.

Essential Functions

• Develop business cases and requirements for new and existing products that support risk adjustment goals, collaborating with software developers to ensure coding aligns with business needs.
• Lead customer requests for ad hoc reports or research.
• Manage customer financial modeling, including Mid-Year and Final Year Payments and Transfer Payments.
• Research and monitor algorithm performance over time, recommending improvements.
• Collaborate with clinicians on outcomes, algorithm performance, and new product development.
• Provide training and guidance on all aspects of the Risk Adjustment process, from data capture to CMS submission and audit validation.
• 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 healthcare data and CMS files (MMR, MOR, etc.).
• Experience with clinical data classification (ICD, HCPCS, CPT) and claims processing.
• Familiarity with submission systems (RAPS, EDPS, Edge) and filtering logic.
• Experience with MA projections and transfer payments preferred.
• Proficiency in SAS and SQL; knowledge of statistics.
• Strong analytical, problem-solving, and communication skills.
• Self-initiative, curiosity, and ability to work in a team environment.
• Snowflake experience is a plus.

Veradigm values diversity and is committed to equal employment opportunity. We support COVID-19 vaccinations and do not offer visa sponsorship for this position. Our comprehensive benefits include holidays, vacation, insurance, and retirement plans. Join us in transforming healthcare and building your career with a diverse and inclusive team.