Risk Adjustment Healthcare Analyst III

About the role

Medica is a nonprofit health plan serving over a million members across Minnesota, Nebraska, Wisconsin, Missouri, and beyond. The Risk Adjustment Healthcare Analyst (P3) is a senior‑level individual contributor responsible for delivering complex, high‑impact analytics and reporting that supports the organization’s Risk Adjustment strategy. The analyst translates healthcare and claims data into actionable insights that inform financial performance, coding accuracy, and regulatory compliance, operating with minimal supervision and serving as a trusted analytical resource to cross‑functional partners.

Responsibilities

• Risk Adjustment Analytics & Reporting: Independently develop, maintain, and enhance complex risk adjustment reporting and analytic solutions, including HCC coding accuracy, RAF score performance, and financial impact analysis. Ensure outputs are accurate, timely, and aligned with business needs.
• Cross‑Functional Partnership: Collaborate closely with actuarial, finance, clinical, quality, and operational partners to support data‑driven decision‑making. Explain results, assumptions, and implications of risk adjustment analytics.
• Data Quality & Validation: Ensure integrity, consistency, and reliability of risk adjustment data through validation and reconciliation processes. Identify data quality issues, conduct root‑cause analysis, and recommend corrective actions.
• Performance Monitoring & Insight Generation: Monitor and analyze key risk adjustment performance indicators, identify trends, variances, and anomalies, and proactively communicate findings to stakeholders.
• Data Visualization & Communication: Design and deliver dashboards and visualizations (e.g., Tableau, Power BI) that clearly communicate complex analytical findings to technical and non‑technical audiences.
• Regulatory & Methodology Awareness: Maintain working knowledge of CMS risk adjustment guidelines and model changes. Ensure analytic outputs and reporting methodologies align with current regulatory requirements.
• Process Improvement: Identify opportunities to improve analytic processes, reporting efficiency, and data usability. Contribute to standardization and documentation of analytic approaches within the team.

Required Qualifications

• Education: Bachelor’s degree in Healthcare Analytics, Data Analytics, Finance, Economics, Healthcare Administration, or a related field. Master’s degree preferred.
• Experience: Minimum of 3 years in healthcare analytics, reporting, or data analysis. Experience supporting risk adjustment, Medicare Advantage, or CMS‑related programs strongly preferred.
• Technical Skills: Understanding of HHS/CMS risk adjustment methodologies. Proficiency in SQL and analytic tools such as Python, SAS, R, or similar.
• Analytical Skills: Strong ability to analyze complex datasets, interpret results, and translate findings into clear, actionable insights.
• Communication & Collaboration: Demonstrated ability to communicate analytical findings effectively and collaborate with cross‑functional partners.
• Attention to Detail: High level of accuracy, organization, and accountability with a strong commitment to data quality.

Pay

The full salary grade for this position is $90,500 – $155,200. The typical hiring salary range is expected to be between $90,500 – $122,835, with placement dependent on education, experience, certifications, scope of responsibility, internal pay equity, and market data.

Benefits

Medica offers a generous total rewards package that includes competitive medical, dental, and vision coverage; paid time off and holidays; paid volunteer time off; 401(k) contributions; caregiver services; and many other benefits to support employees.

Schedule

This is an office role requiring onsite work an average of three days per week. Candidates should be located near one of the following offices: Minnetonka, MN, or Madison, WI.