Reporting - Senior Risk Adjustment Analyst PC# 135-2037

CommunityCare • Tulsa, OK

2d

About The Position

The Senior Risk Adjustment Analyst leads advanced analytics, data governance, and operational processes supporting accurate, compliant, and optimized risk-adjusted revenue across Medicare Advantage and ACA populations. The role requires independent execution, strong technical skills, and the ability to translate complex healthcare data into actionable insights for internal and external stakeholders.

Requirements

• Strong understanding of Medicare Advantage and ACA risk-adjustment models, EDPS/RAPS/EDGE processes, and healthcare data structures.
• Advanced proficiency in SAS or SQL and Power BI.
• Strong analytical, problem-solving, and data interpretation skills.
• Strong written and verbal communication skills, including the ability to present findings clearly to technical and non-technical audiences.
• Demonstrated ability to collaborate with analysts and cross-functional teams.
• Consistent professionalism in interactions with internal and external partners.
• Successful completion of a Health Care Sanctions background check.
• Bachelor’s degree in analytics, statistics, health informatics, business, or a related field.
• At least three years of healthcare analytics, risk adjustment, or population health experience.
• Experience building dashboards, ETL processes, and analytic data models.

Responsibilities

• Co-design and lead risk adjustment analytics for Medicare Advantage and ACA populations, including KPI development and RAF trending.
• Analyze large datasets integrating claims, encounters, pharmacy, eligibility, EDPS/EDGE, and provider data to identify trends, patterns, and anomalies, and synthesize findings into recommendations.
• Develop, modify, and optimize SAS or SQL and Power BI for data extraction, transformation, validation, and analytics.
• Oversee end-to-end EDPS and EDGE submission processes, including data gathering, ETL workflows, file transfers, and vendor or government response-file management.
• Investigate and resolve submission errors, outliers, and rejections; implement process improvements and automation opportunities.
• Build paginated reports and interactive Power BI dashboards, including reusable templates and automated refresh pipelines.
• Create written reports and presentations communicating analytical findings to leadership and operational teams.
• Partner with internal coding, finance, compliance, provider engagement, pharmacy, and IT teams to gather requirements and deliver analytical solutions.
• Support external partners, including providers, delegated entities, and vendors, by clarifying data needs and resolving issues.
• Perform other job-related duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior