Risk Adjustment Analyst

Job Summary

To support a growing Data Analytics team, the full-time remote Sr. Risk Adjustment Solutions Analyst will analyze Medicare Advantage and ACA Risk Adjustment program performance, provide expertise on risk adjustment methodologies, and collaborate across teams to transform healthcare data into actionable insights.

Key Responsibilities

• Analyze Medicare Advantage and ACA Risk Adjustment program performance to identify opportunities for improvement and revenue optimization
• Evaluate operational and financial performance metrics, developing data-driven recommendations and supporting client-facing initiatives
• Develop, optimize, and troubleshoot complex SQL queries and collaborate with cross-functional teams to implement scalable solutions

Required 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 advanced SQL development experience
• Strong understanding of CMS data files, including MMR and MOR, and the end-to-end Risk Adjustment lifecycle