Data Scientist III - Risk Adjustment Compliance

Jobgether-posted 2 months ago

$105,600 - $195,400/Yr

Mid Level

11-50 employees

Resume

Match Score

Upload and Match ResumeTrack Jobs with Teal

This role focuses on leveraging advanced analytics and statistical modeling to ensure the quality and compliance of risk adjustment processes. You will develop models and analytical tools to identify high-risk areas, detect coding anomalies, and evaluate program effectiveness, directly influencing healthcare outcomes. Working cross-functionally, you will collaborate with technical teams, compliance, and executive stakeholders to provide actionable insights. The position emphasizes process automation, quality monitoring, and data-driven decision-making in a fast-paced, regulated environment. It is ideal for a detail-oriented professional passionate about data, compliance, and improving operational efficiency. You will also have opportunities to mentor team members and contribute to the development of scalable, high-impact analytical solutions.

Develop and validate models to detect coding anomalies and identify high-risk areas.
Create analytical tools to assess the quality of risk adjustment data and program effectiveness.
Conduct exploratory data analysis to support regulatory compliance (CMS and OIG).
Monitor quality metrics and recommend opportunities for improvement.
Automate processes to scale analysis and ensure consistency across projects.
Present findings to Risk Adjustment, Legal, Compliance, and executive teams.
Advise Line 1 teams on systemic controls to prevent non-compliance and assist in training Data Analysts.

Bachelor’s degree in Data Science, Statistics, Information Systems, Health Informatics, or related field (or equivalent experience).
5+ years of experience in statistical analysis and modeling.
3+ years of IT experience including data warehouse, coding, or ETL processes.
Experience with Risk Adjustment, Medicare data, ICD-10, HCC, or encounter data preferred.
Hands-on proficiency in statistical tools such as SAS and R programming.
Project management or project implementation experience.
Strong collaboration, communication, and problem-solving skills.

CHDA (Certified Health Data Analyst) preferred.

Comprehensive health, dental, and vision coverage.
401(k) and stock purchase plans.
Tuition reimbursement and professional development opportunities.
Paid time off, holidays, and flexible work schedules (remote, hybrid, or office-based).
Total rewards may include performance-based incentives.

Track Jobs with Teal

Job Search Resources

•

Resume Builder

•

Resume Examples

•

Cover Letter Examples

Data Scientist III - Risk Adjustment Compliance

Job Search Resources

Tools

Career Hubs

Guides

Company