Healthcare Risk Adjustment Analytics (Denver)

Job Overview :

A leading kidney care organization is seeking a Senior Manager, Risk Adjustment Analytics to lead the strategy and execution of risk adjustment analytics within its Integrated Care division. This role plays a crucial part in shaping financial performance through advanced analytics, compliance oversight, and collaboration with cross-functional teams.

If you're passionate about data-driven strategy, healthcare economics, and leading teams, this role offers a dynamic opportunity to drive impact at scale.

Key Responsibilities :

• Oversee and enhance the accuracy of risk adjustment financial models and processes.
• Develop executive-level reporting to monitor revenue metrics and evaluate initiative impacts on Medical Loss Ratio (MLR).
• Utilize SQL to query large datasets from clinical and claims data systems to generate actionable insights.
• Stay informed and compliant with CMS risk adjustment rules, policies, and submission systems.
• Collaborate with finance, operations, clinical, compliance, legal, and IT stakeholders to optimize performance.
• Act as a subject matter expert on CMS risk adjustment trends and best practices.
• Lead and mentor analytics professionals to drive performance.

Required Experience :

Required Skills :