Senior HealthCare Analyst, Risk Adjustment - Jefferson Health Plan

Job Description

Please note: We are seeking a highly analytical and detail-oriented Senior Risk Adjustment Analyst to support our organization’s Medicare Advantage, ACA, and other risk-based programs. This role is critical in reporting, trend analysis, RAF analytics, and provider opportunity targeting.

Minimum Qualifications

• Bachelor’s Degree in Statistics, Mathematics, Economics, Data Science, Public Health, Health Informatics or equivalent experience
• 5 years 5+ years of progressive experience in healthcare analytics (payer, provider, or health tech), including hands on work with claims/encounters and membership/enrollment data.
• Proficiency in SQL and at least one analytics language (Python or R) for data manipulation, analysis, and reproducible workflows.
• Experience building dashboards and reports in applications like Power BI, Tableau, and Qlik.
• Demonstrated ability to structure ambiguous problems, synthesize complex findings, and communicate clearly to executive audiences.
• Experience with Medicare Advantage, Medicaid, and/or Commercial/ACA programs; familiarity with risk adjustment models (e.g., HCC, CDPS+Rx) and quality programs (e.g., HEDIS, Stars).
• Knowledge of provider coding and reimbursement (e.g., CPT, ICD 10, DRG), and managed care operations (UM/CM/DM).
• Exposure to cloud data platforms (e.g., Azure/Synapse/Databricks, Snowflake, BigQuery, or similar) and modern ELT/ETL practices.
• Statistical modeling, forecasting, or predictive analytics experience; A/B testing and causal inference a plus.
• Experience supporting value based care, provider performance analytics, and provider engagement.

Physical Demands

• Lift and carry 25 lbs.
• Frequent sitting/standing
• Frequent keyboard use
• Patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.

Compliance, Privacy, and Security

Uphold HIPAA, CMS/State regulations, and governance standards by maintaining compliant, audit-ready processes and documentation.

Continuous Improvement and Automation

Enhance efficiency through automation, improved data pipelines, and evaluation of emerging tools, including responsible GenAI, to drive productivity and reusability.