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Healthcare Risk Adjustment Analytics (Denver)
Healthcare Risk Adjustment Analytics (Denver)TechMind RPO • Denver, CO, US
Healthcare Risk Adjustment Analytics (Denver)

Healthcare Risk Adjustment Analytics (Denver)

TechMind RPO • Denver, CO, US
1 day ago
Job type
  • Part-time
Job description

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 :

  • 3+ years working with healthcare data, specifically claims or encounter data using SQL.
  • 3+ years of experience in healthcare finance, medical economics, or consulting in population health.
  • 1+ year in designing and assessing risk adjustment initiatives (prospective and retrospective) including CMS RAPS / Encounter submissions.
  • Prior experience in managing and developing direct reports.

    • Required Skills :

  • Deep understanding of CMS-HCC models (V24, V28), claims lifecycle, and compliance regulations.
  • Strong knowledge of healthcare finance, value-based care, and population health metrics.
  • Excellent presentation and storytelling skills, with the ability to convey complex data to senior leadership.
  • High adaptability in dynamic environments, with a self-driven, entrepreneurial approach.
  • Project management expertise and strategic thinking.
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    Risk Adjustment • Denver, CO, US