Principal, Risk Adjustment Analytics Consultant - REMOTE
About the role
At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development.
The Principal Risk Adjustment Consultant drives analytical strategies and solutions to optimize Medicare Risk Adjustment (RA) performance. Leveraging deep healthcare expertise and advanced coding proficiency, this role delivers actionable insights, builds dynamic visualizations, and provides strategic advisory services to internal stakeholders and senior leadership.
Responsibilities
- Analyses for revenue optimization, risk forecasts, HCC coding logic, RADV audits, Medicare segmentation, data & logic governance
- Build interactive visualizations
- Interpret CMS model updates that affect organization-wide strategy and risk adjustment analytics
- Translate highly technical coding, regulatory, and statistical nuances into clear business recommendations for executive leadership
- Lead multiple analytic-related projects in parallel
- Champion initiatives and collaborate with multiple stakeholders to bring initiatives to life
- Deliver high-quality output to senior leadership for decision-making within short timelines
Requirements
- Bachelor's degree and 8 years of experience in health care services, statistical analysis, or insurance industry economics or related field OR
- Master’s degree with 6 years of experience in health care services, statistical analysis, or insurance industry economics or related field OR
- PhD with 4 years of experience in health care services, statistical analysis, or insurance industry economics or related field OR
- 12 years of experience in health care services, statistical analysis, or insurance industry economics or related field
- Understanding and high proficiency in querying a wide variety of internal and external data sources to derive meaningful insights
- Strong analytical skills and proficiency in computer languages, such as SQL, Python, R, etc.
- Ability to create dynamic and visually engaging dashboards leveraging data visualization tools such as Tableau or Power BI
- High degree of business intelligence and ability to take a business case from inception to customer or partner execution
- Excellent communication and presentation skills
- Ability to work independently and as part of a team
- Analytics subject matter expertise
- Performance excellence in working under pressure
Preferred Qualifications
- Deep experience with Medicare Risk Adjustment and Stars
- Advanced analytics & automation using Alteryx or Airflow for data blending and automation
- Proficiency with GitHub for collaborative coding and version control
- Certification or practical experience with project management methodologies and tracking tools (e.g., Agile, Wrike, PMP)
- Exposure to data science in healthcare including hands-on experience working with predictive models, machine learning pipelines, or Large Language Models (LLMs)
Schedule
This is a Remote role.
Pay
Compensation: $102,000.00 - $184,300.00. Exact compensation may vary based on skills, experience, and location.