Sr. Director, Risk Adjustment Data & Analytics (Remote)

Job Duties & Responsibilities

• Lead MRA Data Operations and Ecosystem Quality. Own the end-to-end MRA data ecosystem — spanning data ingestion, transformation, validation, reporting, and analytics across all Risk Adjustment programs. Ensure data is timely, complete, and consistently reliable to support all downstream MRA workflows, from prospective suspecting through CMS submission and reconciliation. Drive Analytical Insights and Program Performance Reporting. Develop and maintain reporting and analytical frameworks that explain what happened, why it happened, and where to intervene across MRA programs. Translate risk score trends, program impacts, and variance drivers into clear, executive-ready narratives and data visualizations that enable confident decision-making. Ensure Audit Readiness, Data Governance, and Compliance. Establish and maintain rigorous data governance standards, controls, and documentation to ensure MRA data is audit-ready, reproducible, and defensible at all times. Partner closely with Compliance to support RADV audits, internal reviews, and CMS regulatory requirements — including full traceability of submissions and supporting evidence. Partner Strategically with Finance, Actuarial, and Clinical Stakeholders. Serve as the primary MRA data partner to Finance and Actuarial teams, providing clarity on risk adjustment program performance, revenue impacts, and variance drivers. Support Clinical Operations and JSA Outreach teams with data that enables precise member identification, chart retrieval coordination, and coding accuracy.
• Direct and Develop the MRA Analytics Team. Lead, grow, and develop a multidisciplinary MRA data team spanning analytics, data science, and data engineering disciplines. Establish clear accountability structures, promote a culture of quality and continuous improvement, and ensure team outputs meet the technical and operational standards required for a highly regulated environment. Identify and Remediate Data Quality and Process Gaps. Proactively identify gaps in data quality, timeliness, or workflow execution and drive corrective actions through system improvements, tooling enhancements, or process redesign. Set and enforce technical and analytical standards — including definitions, assumptions, and validation checks — across all MRA data outputs.

Experience Job Requirements

• 7–10 years of progressive experience in healthcare data, analytics, or data operations, with direct, hands-on experience supporting Medicare Advantage Risk Adjustment programs. Demonstrated experience leading or managing data teams responsible for regulated, audit-sensitive data environments. Proven experience partnering with cross-functional stakeholders including clinical, finance, actuarial, and compliance teams. Demonstrated ownership of complex, end-to-end data pipelines and analytical outputs in a healthcare or regulated industry setting. Experience in a mid-to-large enterprise healthcare or health insurance environment, ideally a Medicare Advantage plan or managed care organization. Must be able to work remotely, with availability from 8:00 AM to 5:00 PM Pacific Standard Time in the U.S.

Education & Training

• Required: Bachelor's degree in Health Informatics, Data Science, Statistics, Computer Science, Mathematics, Healthcare Administration, or a related quantitative field; or an equivalent combination of education, certification, and direct work experience. Preferred: Master's degree in Data Science, Health Informatics, Biostatistics, or a related field. Training Required: No specific required certifications; demonstrated applied expertise in MRA data operations is essential. Preferred: Formal training in data governance frameworks, audit readiness methodologies, or advanced analytics (e.g., DAMA, CDMP, or equivalent). Training in Medicare Advantage regulations, CMS reporting requirements (encounter data, RADV, HEDIS, STAR ratings, interoperability), and general health plan operations.

Required Skills & Competencies

• Technical / Hard Skills: Medicare Risk Adjustment (MRA) Operations (Advanced) — Deep expertise in HCC coding, ICD-10 coding principles, RAF score calculation, CMS encounter data submission, and RADV audit requirements. Data Analytics & Statistical Modeling (Advanced) — Strong analytical and modeling skills, including the ability to translate complex MRA program outcomes into quantitative metrics and executive-ready narratives. Business Intelligence & Reporting Tools (Advanced) — Proficiency in Power BI, Tableau, or equivalent BI platforms; advanced spreadsheet modeling using Excel or Google Sheets. SQL & Data Querying (Advanced) — Proficiency in SQL for data extraction, transformation, and analysis across large healthcare claims and encounter data sets; familiarity with Python or R is a plus. Cloud & Data Platform Literacy (Advanced) — Familiarity with cloud data environments (Azure, AWS, GCP), data warehousing solutions, and integration with enterprise BI and analytics platforms.

Pay Range

$198,219.00 - $297,329.00