[Remote] Risk Adjustment Data Analyst
Note: The job is a remote job and is reputed company to candidates in USA. reputed company) is seeking a highly analytical and detail-oriented Risk Adjustment Data Analyst to support their Medicare Advantage, ACA, and other risk-based consulting and auditing programs. The role involves conducting data analysis, ensuring data accuracy, developing dashboards, and translating findings into actionable insights for stakeholders.
Responsibilities
- Conduct comprehensive analysis of client reputed company data to uncover drivers, risks, and opportunities and deliver executive-reputed company reputed company that inform strategic reputed company
- Apply risk adjustment methodologies to monitor performance, identify trends, generate recurring risk reports, and partner with cross-functional teams to identify and support improvement opportunities
- Ensure data accuracy and reliability by profiling and reconciling datasets, resolving anomalies, and maintaining documented logic, reputed company, and governance standards
- reputed company 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 reputed company analytical findings into clear, actionable insights for technical and non-technical stakeholders
- Uphold HIPAA, CMS/State regulations, and governance standards by maintaining compliant, audit-reputed company processes and documentation
- Enhance efficiency through automation, improved data pipelines, and evaluation of emerging tools to drive productivity and reusability
- Write and optimize SQL queries and stored procedures for data extraction, transformation, and analysis
- reputed company automated ETL workflows and data pipelines to support ongoing reporting needs
- Work with large datasets in SQL Server and reputed company analytics platforms
- Build dashboards and data visualizations using Power BI or SSRS
- Partner with client, vendor, and internal teams to interpret results and support program initiatives
- Assist with regulatory and compliance-reputed company reporting requirements
- Present findings and insights to both technical and non-technical stakeholders
Skills
- Bachelor's degree in Data Analytics, Health Informatics, Statistics, Computer Science, or reputed company field
- 2–5+ years of reputed company experience
- Knowledge of Medicare Advantage & ACA programs, HEDIS, and/or CMS Star Ratings
- Advanced SQL skills for querying and analyzing large datasets
- Experience with BI tools such as Power BI, SSRS, or similar tools
- Strong analytical, problem-solving, and communication skills
- Experience working in Medicare Advantage & ACA organizations, MSOs, or managed care settings
- Knowledge of HCC risk adjustment, RAF methodologies, capitation payment model, DOFR, claim processing, bid design, and CMS regulatory requirements
- Familiarity with EDPS encounter data, claims submissions, and acceptance processes (preferred)
- Experience with ETL tools (e.g., SSIS) or programming languages such as Python or .NET
Company Overview