Senior HealthCare Analyst, Risk Adjustment - Jefferson Health Plan
About The Position
The Senior Healthcare Data Analyst delivers actionable analytics that support enterprise clinical, operational, and financial decisions. The role develops reliable data assets, creates insightful reporting, and applies advanced analytical techniques to drive measurable outcomes in partnership with cross functional teams—while maintaining strong compliance and data governance standards. Note: Program specifics (e.g., Medicare Advantage, Medicaid, Commercial/ACA, Quality/Stars/HEDIS, Value Based Care, Risk Adjustment) and team tools will be listed in the job posting for each department. Please note: We are seeking a highly analytical and detail-oriented Senior Risk Adjustment Analyst to support our organization’s Medicare Advantage, ACA, and other risk-based programs. This role is critical in reporting, trend analysis, RAF analytics, and provider opportunity targeting. The ideal candidate understands CMS risk-adjustment methodologies, coding impacts, and can turn data insights into actionable strategies for coding, CDI, and clinical teams. Experience with RADV audits and compliance is preferred.
Requirements
- Bachelor’s Degree Statistics, Mathematics, Economics, Data Science, Public Health, Health Informatics or equivalent experience
- 5+ years of progressive experience in healthcare analytics (payer, provider, or health tech), including hands on work with claims/encounters and membership/enrollment data.
- Proficiency in SQL and at least one analytics language (Python or R) for data manipulation, analysis, and reproducible workflows.
- Experience building dashboards and reports in applications like Power BI, Tableau, and Qlik.
- Demonstrated ability to structure ambiguous problems, synthesize complex findings, and communicate clearly to executive audiences.
- Experience with Medicare Advantage, Medicaid, and/or Commercial/ACA programs; familiarity with risk adjustment models (e.g., HCC, CDPS+Rx) and quality programs (e.g., HEDIS, Stars).
- Knowledge of provider coding and reimbursement (e.g., CPT, ICD 10, DRG), and managed care operations (UM/CM/DM).
- Exposure to cloud data platforms (e.g., Azure/Synapse/Databricks, Snowflake, BigQuery, or similar) and modern ELT/ETL practices.
- Statistical modeling, forecasting, or predictive analytics experience; A/B testing and causal inference a plus.
- Experience supporting value based care, provider performance analytics, and provider engagement.
Nice To Haves
- Experience with RADV audits and compliance is preferred.
Responsibilities
- Conduct comprehensive analysis of utilization, cost, quantity, and outcomes to uncover drivers, risks, and opportunities and deliver executive-ready insight that inform strategic decisions
- Apply risk adjustment methodologies to monitor revenue, generate recurring risk reports, and partner with cross-functional teams to identify and support score-improvement opportunities.
- Ensure data accuracy and reliability by profiling and reconciling datasets, resolving anomalies, and maintaining documented logic, lineage, and governance standards.
- Develop and maintain user-friendly dashboards and automated reports, standardizing key metrics and refresh schedules to support leaders and providers.
- Serve as a subject matter expert and translate complex analytical findings into clear, actionable insights for technical and non-technical stakeholders.
- Lead analytic projects end-to-end and mentor peers by promoting best practices in methodology, coding, documentation, and visualization.
- Uphold HIPAA, CMS/State regulations, and governance standards by maintaining compliant, audit-ready processes and documentation.
- Enhance efficiency through automation, improved data pipelines, and evaluation of emerging tools, including responsible GenAI, to drive productivity and reusability.
Benefits
- medical (including prescription)
- supplemental insurance
- dental
- vision
- life and AD&D insurance
- short- and long-term disability
- flexible spending accounts
- retirement plans
- tuition assistance
- voluntary benefits
- tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service
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What This Job Offers
Job Type
Full-time
Career Level
Senior
