Principal, Risk Adjustment Analytics Consultant - REMOTE
About The Position
The Principal Risk Adjustment Consultant drives analytical strategies and solutions to optimize Medicare Risk Adjustment (RA) performance. Leveraging deep healthcare expertise and advanced coding proficiency, this role delivers actionable insights, builds dynamic visualizations, and provides strategic advisory services to internal stakeholders and senior leadership. Core responsibilities include analyses for revenue optimization, risk forecasts, HCC coding logic, RADV audits, Medicare segmentation, data & logic governance. The Principal Risk Adjustment Consultant will build interactive visualizations, interpret CMS model updates that affect organization-wide strategy and risk adjustment analytics and translate highly technical coding, regulatory, and statistical nuances into clear business recommendations for executive leadership.
Requirements
- Bachelor's degree and 8 years of experience in health care services, statistical analysis, or insurance industry economics or related field OR Master’s degree with 6 years of experience in health care services, statistical analysis, or insurance industry economics or related field OR PhD with 4 years of experience in health care services, statistical analysis, or insurance industry economics or related field OR 12 years of experience in health care services, statistical analysis, or insurance industry economics or related field
- Understanding and high proficiency at querying a wide variety of internal and external data sources to get meaningful insights.
- Strong analytical skills and proficiency in computer languages, such as SQL, Python, R, etc.
- Ability to create a dynamic and visually engaging dashboard leveraging data visualization tools such as Tableau or Power BI.
- High degree of business intelligence and understanding how to take a business case from inception to customer or partner execution.
- Excellent communication and presentation skills.
- Ability to work independently and as part of a team.
- Ability to lead multiple analytic related projects in parallel.
- Analytics subject matter expert.
Nice To Haves
- Deep experience with Medicare Risk Adjustment and Stars.
- Advanced analytics & automation using Alteryx or Airflow for data blending and automation.
- Proficiency with GitHub for collaborative coding and version control.
- Certification or practical experience with project management methodologies and tracking tools (e.g., Agile, Wrike, PMP), and exposure to data science in healthcare including hands-on experience working with predictive models, machine learning pipelines, or Large Language Models (LLMs).
Responsibilities
- Drives analytical strategies and solutions to optimize Medicare Risk Adjustment (RA) performance.
- Delivers actionable insights, builds dynamic visualizations, and provides strategic advisory services to internal stakeholders and senior leadership.
- Performs analyses for revenue optimization, risk forecasts, HCC coding logic, RADV audits, Medicare segmentation, data & logic governance.
- Builds interactive visualizations.
- Interprets CMS model updates that affect organization-wide strategy and risk adjustment analytics.
- Translates highly technical coding, regulatory, and statistical nuances into clear business recommendations for executive leadership.
- Champions initiatives and collaborates with multiple stakeholders to bring the initiative to life.
- Works under pressure and delivers high-quality output to senior leadership for decision-making within a short timeline.
Benefits
- Health and wellness benefits
- 401(k) savings plan
- Pension plan
- Paid time off
- Paid parental leave
- Disability insurance
- Supplemental life insurance
- Employee assistance program
- Paid holidays
- Tuition reimbursement
- Other incentives
- Annual incentive bonus plan
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What This Job Offers
Job Type
Full-time
Career Level
Principal
