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Advantmed provides healthcare consulting and technology-enabled services for health plans and healthcare providers. Its work spans risk adjustment, quality improvement, health assessments, member engagement, care-gap identification, and accurate reimbursement. Through the Elevate^ platform, Advantmed gives clients real-time visibility into healthcare data and actionable insights designed to support better care delivery, stronger operational performance, and more reliable financial outcomes. The company serves organizations across the healthcare and insurance sectors, with its listed industries also including logistics.
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.
Description
- 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
Requirements
- 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
Benefits
- 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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