Sr. Director, Risk Adjustment Data & Analytics

Alignment Health

1d•$198,219 - $297,329•Remote

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. The Sr. Director, Risk Adjustment Data & Analytics (Remote) is a senior technical and operational leader responsible for advancing the integrity, completeness, and strategic value of Medicare Risk Adjustment (MRA) data and analytics programs within the organization. This role serves as the primary accountable leader for MRA data operations — owning the analytical and data engineering infrastructure that enables suspecting, chart review, coding, submission, and reconciliation workflows to operate at scale. Working cross-functionally with MRA Business leadership, Finance, Actuarial, Clinical Operations, Compliance, and enterprise IT teams, this leader ensures that all key stakeholders are working from consistent, trusted, and defensible MRA data. The role leads a multidisciplinary team of analysts, data scientists, and data engineers, setting analytical standards and translating program outcomes into clear, actionable insights for senior leadership. This role is critical to the organization because Risk Adjustment Factor (RAF) scores directly drive plan revenue, making accurate, timely, and defensible MRA data a high-stakes organizational priority — and the Senior Director is the operational owner of that capability.

Requirements

7–10 years of progressive experience in healthcare data, analytics, or data operations, with direct, hands-on experience supporting Medicare Advantage Risk Adjustment programs.
Demonstrated experience leading or managing data teams responsible for regulated, audit-sensitive data environments.
Proven experience partnering with cross-functional stakeholders including clinical, finance, actuarial, and compliance teams.
Demonstrated ownership of complex, end-to-end data pipelines and analytical outputs in a healthcare or regulated industry setting.
Experience in a mid-to-large enterprise healthcare or health insurance environment, ideally a Medicare Advantage plan or managed care organization.
Bachelor's degree in Health Informatics, Data Science, Statistics, Computer Science, Mathematics, Healthcare Administration, or a related quantitative field; or an equivalent combination of education, certification, and direct work experience.
Medicare Risk Adjustment (MRA) Operations (Advanced) — Deep expertise in HCC coding, ICD-10 coding principles, RAF score calculation, CMS encounter data submission, and RADV audit requirements.
Data Analytics & Statistical Modeling (Advanced) — Strong analytical and modeling skills, including the ability to translate complex MRA program outcomes into quantitative metrics and executive-ready narratives.
Business Intelligence & Reporting Tools (Advanced) — Proficiency in Power BI, Tableau, or equivalent BI platforms; advanced spreadsheet modeling using Excel or Google Sheets.
SQL & Data Querying (Advanced) — Proficiency in SQL for data extraction, transformation, and analysis across large healthcare claims and encounter data sets; familiarity with Python or R is a plus.
Cloud & Data Platform Literacy (Advanced) — Familiarity with cloud data environments (Azure, AWS, GCP), data warehousing solutions, and integration with enterprise BI and analytics platforms.

Nice To Haves

Experience building or scaling data and analytics functions within a health plan or insurance organization.
Experience working with chart retrieval vendors and provider partners to coordinate medical records access.
Experience implementing coding and auditing platforms (e.g., Episource, Veradigm, Cotiviti).
Master's degree in Data Science, Health Informatics, Biostatistics, or a related field.
Formal training in data governance frameworks, audit readiness methodologies, or advanced analytics (e.g., DAMA, CDMP, or equivalent).
Training in Medicare Advantage regulations, CMS reporting requirements (encounter data, RADV, HEDIS, STAR ratings, interoperability), and general health plan operations.
Certified Risk Adjustment Coder (CRC) issued by AAPC, or Certified Professional Coder (CPC); or relevant data science/analytics certifications (e.g., CDMP, Databricks, Microsoft Azure Data Fundamentals).