Sr. Risk Adjustment Solutions Analyst

ABOUT ADVANTMEDAdvantmed is a leading provider of risk adjustment, quality improvement, and value-based solutions to health plans and providers. We drive market leading performance with integrated technology, service, and program solutions that improve the risk adjustment and quality programs of our partners. Our solutions focus on identifying, managing, and documenting risk and quality performance, and the proactive clinical engagement of high acuity populations. About the RoleWe are seeking a highly motivated and experienced Risk Adjustment Specialist to join our growing Data Analytics team. This role is ideal for a healthcare analytics professional with deep expertise in Medicare Advantage, ACA Risk Adjustment, CMS data, and healthcare analyticsThe successful candidate will serve as a trusted subject matter expert, partnering with clients, operations, technology, and leadership teams to transform complex healthcare data into actionable insights that drive Risk Adjustment performance, improve operational efficiency, and support strategic decision-making Key Responsibilities Risk Adjustment Analytics & StrategyAnalyze Medicare Advantage and ACA Risk Adjustment program performance to identify opportunities for RAF improvement and revenue optimizationProvide expertise on CMS-HCC, RxHCC, Medicare Risk Adjustment methodologies, and industry best practicesEvaluate operational and financial performance metrics and develop data-driven recommendationsSupport client-facing initiatives, business reviews, and executive presentations Healthcare Data AnalysisAnalyze, cleanse, transform, reconcile, and validate large healthcare datasets from multiple sourcesPerform analysis across Claims, Encounters, Eligibility, Pharmacy, Medical Record Review (MRR), and Health Assessment datasetsIdentify trends, anomalies, and opportunities through detailed data analysisConduct root cause analysis and recommend corrective actions to improve data integrity and operational performance CMS Data Management & ReportingWork extensively with CMS data sources, including MMR, MOR, and other Medicare Advantage datasetsSupport Risk Adjustment reconciliation, forecasting, and financial impact analysisDevelop operational reports, scorecards, ad hoc analyses, and executive dashboardsTranslate complex analytical findings into meaningful business recommendations Technical & Cross-Functional CollaborationDevelop, optimize, and troubleshoot complex SQL queries, stored procedures, and data extraction processesDebug existing reporting and analytical scriptsCollaborate with business, operations, technology, and analytics teams to implement scalable solutionsSupport automation, process improvement, and operational excellence initiatives Requirements EducationBachelor's degree in Healthcare, Statistics, Computer Science, Engineering, Business Analytics, or related field Experience5+ years of healthcare data analytics experience, including data mining, mapping, transformation, validation, and reporting3+ years of hands-on experience in Medicare Advantage and/or ACA Risk Adjustment3+ years of experience as a Healthcare Data Analyst3+ years of advanced SQL development experience Healthcare & Risk Adjustment ExpertiseStrong understanding ofMedicare Advantage and ACA Risk Adjustment programsCMS-HCC and RxHCC modelsMedical Record Review (MRR) and Health Assessment processesClaims, Encounter, Eligibility, and Pharmacy dataCMS data files, including MMR and MOREnd-to-end Risk Adjustment lifecycleHEDIS and healthcare quality measures Technical SkillsAdvanced SQL and Microsoft SQL ServerSQL Server Management Studio (SSMS)Data mapping, reconciliation, and validationRoot cause analysis and data quality managementAd hoc reporting and data extraction Professional SkillsStrong analytical and problem-solving abilitiesExcellent communication and presentation skillsExperience working directly with clients and executive stakeholdersAbility to independently manage multiple priorities in a fast-paced environment Preferred QualificationsExperience supporting Medicare Advantage health plans, provider groups, or Risk Adjustment vendorsExperience with Power BI, Tableau, or other Business Intelligence platformsKnowledge of Risk Adjustment financial forecasting and revenue analyticsExperience leading client solutioning discussions and strategic initiativesExposure to automation, process optimization, and operational excellence programsFamiliarity with FHIR, EMR/EHR integrations, and healthcare interoperability standards What You'll BringDeep expertise in Risk Adjustment and healthcare analyticsAbility to convert complex healthcare data into actionable business insightsStrong client-facing and consultative skillsA continuous improvement mindset focused on operational excellence and innovationThe ability to work independently while collaborating effectively across teams Benefits Why Join Us?This is an opportunity to make a measurable impact on healthcare outcomes and financial performance by leveraging your expertise in Risk Adjustment, analytics, and strategic consulting. You will work alongside industry experts, solve complex business challenges, and help clients optimize their Risk Adjustment programs through data-driven decision-making. If you are passionate about healthcare analytics, Risk Adjustment, and solving complex problems, we would love to hear from you. Compensation for this role will be determined based on the selected candidate's experience and qualifications.Health Care Plan (Medical, Dental & Vision)Annual Performance BonusRetirement Plan (401k, IRA)Life Insurance (Basic, Voluntary & AD&D)Paid Time Off (Vacation, Sick & Public Holidays)Family Leave (Maternity, Paternity)Short Term & Long Term DisabilityWork From HomeWellness Resources