Manager of Risk Adjustment Analytics

Key skills and experience we are looking for include:

• Deep understanding of Risk Adjustment and Medicare Advantage programs.
• Strong analytical and reporting capabilities, including recapture rate and RAF trend analysis.
• Advanced SQL skills and experience working with large healthcare datasets.
• Experience creating and managing 837 encounter files.
• Knowledge of claims data, encounter submissions, and CMS reporting processes.
• Experience managing retrospective chart review outcomes, including adds and deletes submitted to CMS.
• Ability to transform complex data into meaningful, actionable reporting for leadership.
• Strong communication skills and the ability to connect analytics to broader business and operational goals.

• 6-10 years in risk adjustment and/or healthcare analytics
• Deep expertise in Medicare Advantage risk adjustment, HCC modeling, and CMS methodologies
• Strong knowledge of value-based care contracts, policy, operations, and financial methods
• Proficiency with SAS, SQL, and data mining tools
• Bachelor's degree required (Master's preferred)