HomeData Science Jobs- USAInsight Global | Hiring | Senior Risk Adjustment Analyst (Healthcare) | California...

Insight Global | Hiring | Senior Risk Adjustment Analyst (Healthcare) | California | BigDataKB.com | 5 Oct 2022

Job Location: California

Must Haves

  • Bachelor’s Degree in a highly quantitative field (i.e., Statistics, Mathematics, Actuarial Science, Economics, Accounting/Finance, or Computer Science), plus a minimum of 7 years of experience in data analysis OR High School Education or equivalent, plus a minimum of 9 years of experience in data analysis
  • Expertise in SQL, Tableau, VB/VBA programming and relational database skills
  • Advanced knowledge & understanding of risk adjustment in healthcare including common risk adjustment models (i.e., CMS-HCC (medicare), HHS-HCC (ACA) and CDPS+Rx (Medicaid)


  • Master’s Degree
  • Understanding of managed care and health care data sources, including common coding standards (i.e., ICD-10, CPT/HCPCS)
  • Experience working with multiple data systems and multiple data reporting tools
  • Knowledge of Tableau or other data visualization software
  • Excellent written and verbal communication skills with an ability to interpret and communicate analytical information to both individuals and groups in a clear and concise manner
  • Demonstrated ability to work effectively, both independently and in a team setting, with individuals having diverse professional backgrounds including business, technical and/or clinical
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The Senior Risk Adjustment Analyst supports the complete and accurate capture of conditions for members enrolled in government programs, maintaining compliance with CMS standards, ensuring the Company receives the appropriate reimbursement to help cover the conditions of enrollees; leads business data operations by designing statistical methods that provide insight into the coding practices of providers; implements data systems for the analysis of Medicare and ACA Risk Adjustment diagnoses; models financial impacts of changes in risk adjustment data and methodologies; collaborates regularly with internal departments and external vendors on risk adjustment projects; gathers, standardizes and consolidates financial claims, membership and premium data into SAS data sets used for risk adjustment analytical and reporting needs; leverages industry resources to increase knowledge and improve ROI of risk adjustment activities; and analyzes the impact of Risk Adjustment Programs identifying process improvements and opportunities to achieve efficiency and effectiveness. Successful candidates will be seasoned data/finance analysts with experience working in the CMS-HCC and/or HHS-HCC Risk Adjustment Models and be knowledgeable of CMS payment files and Risk Adjustment data.

Job Type: Full-time

Pay: $100,000.00 – $110,000.00 per year


  • 8 hour shift


  • Bachelor’s (Preferred)


  • SQL and Tableau: 3 years (Required)
  • Risk Adjustment for Medicare, ACA and Medicaid: 3 years (Required)

Work Location: Remote

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