Director, RADV Program Analytics & Risk Reporting

Alignment Health • Orange, CA

75d • $172,364 - $258,547

About The Position

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. Reporting to the VP of Medicare Advantage RADV Programs, the Director of RADV Programs, Analytics & Reporting, is responsible for managing and overseeing the development of RADV risk exposure models, extrapolation impact analysis, and audit forecasting tools. This individual ensures the integrity of audit data, provides leadership on data governance, and supports executive decision-making with accurate risk metrics.

Requirements

• A minimum of 7 years’ experience in data science or a related field, with at least 5 years in a leadership role managing data science teams.
• Bachelor's degree in computer science, IT or equivalent experience.
• Extensive experience working with large, complex data sets, including clinical and healthcare data, and proficiency in data integration from various sources.

Nice To Haves

• Experience in a large health system strongly preferred.
• Microsoft SQL Server, Power BI, Python, or Azure Certification/Experience.

Responsibilities

• Cross-functional collaboration: Working closely with other departments (Risk Adjustment Operations, Finance, DTS, Compliance, etc.) to ensure accurate data for financial risk modeling.
• Ensure data governance and integrity for all risk adjustment and HCC related metrics.
• Translate business requirements into specifications that will be used to implement the required BI Solutions and dashboards.
• Work with data engineers to ensure that data sets feeding the analytics platforms are tuned for optimal performance.
• Work with business stakeholders to define and improve standardized and ad-hoc analytics/reporting capabilities.
• Design, model, develop, and optimize stored procedures to meet data management and data reporting objectives.
• Oversee the reconciliation of audited HCCs against submitted claims data and standard CMS files.
• Direct analysts in data validation, dashboard development, and audit metrics reporting.
• Present audit trend analysis to leadership and regulatory committees.
• Track progress and performance metrics; escalate risks to leadership as needed.
• Develop and maintain standard operating procedures (SOPs & P&Ps) for CMS HCC/risk adjustment models and RADV analytics workflows.
• Evaluate, implement, and optimize performance management and analytics tools to streamline processes and improvement and user experience.

Benefits

• Equal Opportunity/Affirmative Action Employer.
• Opportunities for growth and innovation.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Bachelor's degree
• Number of Employees: 1,001-5,000 employees