Risk Adjustment Healthcare Analyst

Medica•Madison, WI

2d•Hybrid

About The Position

The Risk Adjustment Healthcare Analyst (P3) is a senior-level individual contributor responsible for delivering complex, high-impact analytics and reporting that supports the organization’s Risk Adjustment strategy. This role translates healthcare and claims data into actionable insights that inform financial performance, coding accuracy, and regulatory compliance. Operating with minimal supervision, the analyst independently owns assigned analytics and reporting deliverables and serves as a trusted analytical resource to cross-functional partners including actuarial, finance, clinical, and operational teams. The role requires strong applied analytics expertise, solid understanding of CMS risk adjustment methodologies, and the ability to clearly communicate insights to diverse audiences.

Requirements

Bachelor’s degree in Healthcare Analytics, Data Analytics, Finance, Economics, Healthcare Administration, or a related field. Master’s degree preferred.
Minimum of 3 years of experience in healthcare analytics, reporting, or data analysis. Experience supporting risk adjustment, Medicare Advantage, or CMS-related programs strongly preferred.
Proficiency in SQL and analytic tools such as SAS, R, or similar. Experience with data visualization tools such Power BI. Experience with Snowflake and other data management platforms.
Strong ability to analyze complex datasets, interpret results, and translate findings into clear, actionable insights.
Demonstrated ability to communicate analytical findings effectively and collaborate with cross-functional partners.
High level of accuracy, organization, and accountability, with a strong commitment to data quality.

Responsibilities

Independently develop, maintain, and enhance complex risk adjustment reporting and analytic solutions, including HCC coding accuracy, RAF score performance, and financial impact analysis. Ensure outputs are accurate, timely, and aligned with business needs.
Collaborate closely with actuarial, finance, clinical, quality, and operational partners to support data-driven decision-making. Serve as an analytical resource by explaining results, assumptions, and implications of risk adjustment analytics.
Ensure the integrity, consistency, and reliability of risk adjustment data through established validation and reconciliation processes. Identify data quality issues, conduct root-cause analysis, and recommend corrective actions.
Monitor and analyze key risk adjustment performance indicators. Identify trends, variances, and anomalies, and proactively communicate findings and implications to stakeholders.
Design and deliver dashboards and visualizations (e.g., Tableau, Power BI) that clearly communicate complex analytical findings to technical and non-technical audiences.
Maintain working knowledge of CMS risk adjustment guidelines and model changes. Ensure analytic outputs and reporting methodologies align with current regulatory requirements.
Identify opportunities to improve analytic processes, reporting efficiency, and data usability. Contribute to standardization and documentation of analytic approaches within the team.