Job Details
The Senior Healthcare Data Analyst delivers actionable analytics that support enterprise clinical, operational, and financial decisions. The role develops reliable data assets, creates insightful reporting, and applies advanced analytical techniques to drive measurable outcomes in partnership with cross functional teams—while maintaining strong compliance and data governance standards.
Note: Program specifics (e.g., Medicare Advantage, Medicaid, Commercial/ACA, Quality/Stars/HEDIS, Value Based Care, Risk Adjustment) and team tools will be listed in the job posting for each department.
Job Description
Please note:
We are seeking a highly analytical and detail-oriented Senior Risk Adjustment Analyst to support our organization’s Medicare Advantage, ACA, and other risk-based programs. This role is critical in reporting, trend analysis, RAF analytics, and provider opportunity targeting. The ideal candidate understands CMS risk-adjustment methodologies, coding impacts, and can turn data insights into actionable strategies for coding, CDI, and clinical teams. Experience with RADV audits and compliance is preferred.
- Analytics and Insight Generation: Conduct comprehensive analysis of utilization, cost, quantity, and outcomes to uncover drivers, risks, and opportunities and deliver executive-ready insight that inform strategic decisions
- Risk Adjustment and Revenue Integrity (as applicable): Apply risk adjustment methodologies to monitor revenue, generate recurring risk reports, and partner with cross-functional teams to identify and support score-improvement opportunities.
- Data Engineering Lite and Data Quality: Ensure data accuracy and reliability by profiling and reconciling datasets, resolving anomalies, and maintaining documented logic, lineage, and governance standards.
- Reporting and Visualization: Develop and maintain user-friendly dashboards and automated reports, standardizing key metrics and refresh schedules to support leaders and providers.
- Stakeholder Partnership and Communication: Serve as a subject matter expert and translate complex analytical findings into clear, actionable insights for technical and non-technical stakeholders.
- Project Leadership and Mentorship: Lead analytic projects end-to-end and mentor peers by promoting best practices in methodology, coding, documentation, and visualization.
- Compliance, Privacy, and Security: Uphold HIPAA, CMS/State regulations, and governance standards by maintaining compliant, audit-ready processes and documentation.
- Continuous Improvement and Automation: Enhance efficiency through automation, improved data pipelines, and evaluation of emerging tools, including responsible GenAI, to drive productivity and reusabili