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Senior Risk Adjustment Solutions Analyst - Remote, United States
Advantmed is seeking a senior analyst to improve healthcare data quality, Medicare Advantage analytics, SQL reporting, and risk adjustment revenue performance.
विवरण
- Assess Medicare Advantage and ACA Risk Adjustment performance to uncover RAF improvement and revenue optimization opportunities
- Apply expertise in CMS-HCC, RxHCC, Medicare Risk Adjustment methodologies, and industry practices
- Review operational and financial metrics and produce data-informed recommendations
- Contribute to client initiatives, business reviews, and executive presentations
- Analyze, cleanse, transform, reconcile, and validate large healthcare datasets from varied sources
- Analyze Claims, Encounters, Eligibility, Pharmacy, Medical Record Review (MRR), and Health Assessment data
- Use detailed analysis to identify trends, anomalies, and improvement opportunities
- Investigate root causes and recommend corrective actions that strengthen data integrity and operational performance
- Work extensively with CMS sources, including MMR, MOR, and other Medicare Advantage datasets
- Assist with Risk Adjustment reconciliation, forecasting, and financial impact analysis
- Create operational reports, scorecards, ad hoc analyses, and executive dashboards
- Convert complex analytical results into actionable business recommendations
- Build, optimize, and troubleshoot complex SQL queries, stored procedures, and data extraction workflows
- Debug existing reporting and analytical scripts
- Partner with business, operations, technology, and analytics teams to deliver scalable solutions
- Contribute to automation, process improvement, and operational excellence initiatives
आवश्यकताएँ
- Bachelor's degree in Healthcare, Statistics, Computer Science, Engineering, Business Analytics, or a related field
- At least 5 years of healthcare data analytics experience, including data mining, mapping, transformation, validation, and reporting
- At least 3 years of hands-on experience with Medicare Advantage and/or ACA Risk Adjustment
- At least 3 years of experience as a Healthcare Data Analyst
- At least 3 years of advanced SQL development experience
- Strong knowledge of Medicare Advantage and ACA Risk Adjustment programs
- Strong knowledge of CMS-HCC and RxHCC models
- Strong knowledge of Medical Record Review (MRR) and Health Assessment processes
- Strong knowledge of Claims, Encounter, Eligibility, and Pharmacy data
- Strong knowledge of CMS data files, including MMR and MOR
- Strong knowledge of the complete Risk Adjustment lifecycle
- Strong knowledge of HEDIS and healthcare quality measures
- Advanced SQL and Microsoft SQL Server skills
- Experience with SQL Server Management Studio (SSMS)
- Experience with data mapping, reconciliation, and validation
- Experience with root cause analysis and data quality management
- Experience producing ad hoc reports and extracting data
- Strong analytical and problem-solving skills
- Excellent communication and presentation skills
- Experience working directly with clients and executive stakeholders
- Ability to manage multiple priorities independently in a fast-paced environment
लाभ
- Medical, dental, and vision health care plan
- Annual performance bonus
- 401(k) or IRA retirement plan
- Basic, voluntary, and AD&D life insurance
- Paid vacation, sick leave, and public holidays
- Maternity and paternity family leave
- Short-term and long-term disability coverage
- Work-from-home arrangement
- Wellness resources
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