Share this Job
Apply now »


Department:  Business Services
Status:  Full Time
Shift:  1st

The Risk Adjustment Senior Analyst provides advanced analytical support to the Risk Adjustment Team. The Analyst is engaged in the department’s mission to improve Medical Group quality and performance for their Medicare Advantage population through the various internal and vendor supplied risk adjustment programs. Lead data analysis and interpretation of CMS and contracted Health Plan reporting and guidance, develop ad-hoc reports, maintain existing reports and dashboards, monitor program operation from a revenue perspective, and measure overall program success. 


Essential Functions

  • Generate and analyze reports related to risk adjustment to support business operations, prioritization, and provider outreach campaigns to help ensure accurate capture and closure of chronic condition gaps.
  • Develop methods to support the access, storage, and reporting of data sets that result from risk adjustment program initiatives.
  • Ensure all risk adjustment measures and dashboards internally (QlikView) and externally (Vendor supplied) are evaluated to ensure reporting accuracy, data integrity, and process efficiency.
  • Collaborate directly with internal and external business units to identify opportunities to improve processes and submissions to ensure ability to meet compliance and revenue goals; identify, correct, and/or assist in resolution of data quality errors.
  • Effectively visualize and communicate the insights, patterns, and trends from various data sets (e.g., Excel, PowerPoint, Tableau, QlikView).
  • Work with a variety of reporting platforms, systems, sources, and data formats.
  • Offer solutions for reporting and analytical needs.
  • Work closely with the Risk Adjustment team to understand business requirements and project deliverables.
  • Develop and maintain knowledge of key performance indicators related to Medicare Risk Adjustment and Hierarchical Condition Categories (HCCs).
  • Leads projects or tasks that arise and utilizes the team to the best of its ability.
  • Trains new risk analytics staff as required.
  • Acts as an expert in their field and internal resource for not only their team but for other areas within the department.
  • Perform other duties as assigned.




  • Bachelor’s degree in Business, Finance, Math, Computer Science or another quantitative field required. Master’s preferred.  
  • 5+ years in analytics role; 3+ years’ healthcare experience. Medicare Advantage risk adjustment experience preferred.
  • Skilled at analyzing large data sources; strong SQL/SAS skills.
  • Knowledge of RAPS, EDPS, healthcare EDI.
  • Strong understanding of risk scoring models.


Skills or Other Qualifications



  • Proficiency in MS Word, Excel, PowerPoint, and Access.
  • Good written, oral communication, interpersonal, and organizational skills.
  • The ability to work both independently and as a team.


License and Certifications




Nearest Major Market: Orange County
Nearest Secondary Market: Los Angeles

Job Segment: Clinic, Risk Management, Medical, Developer, Computer Science, Finance, Healthcare, Technology

Apply now »