Risk Adjustment Analytics Manager

A company is looking for a Sr Manager, Risk Adjustment Analytics.

Key Responsibilities

Lead financial and strategic aspects of CMS risk adjustment to provide actionable insights for executive decision-making

Create and maintain leadership reports on revenue financials and the impact of initiatives on Medical Loss Ratio (MLR)

Develop SQL queries against clinical operations and medical claims data to support analytics and stakeholder insights

Required Qualifications, Training, and Education

Bachelor's or Master's Degree preferred

Expert knowledge of CMS-HCC models V24 and V28

Understanding of claims data lifecycle and submission systems

Knowledge of regulations, compliance, and audits related to risk adjustment