Senior Risk Adjustment Analyst

Job Description

Summary ‎ Lead / Senior BOI/Risk Adjustment Analyst serves as a strategic and technical leader supporting the organization’s Burden of Illness (BOI) programs, focusing MSSP ACOs, Medicare Advantage, Commercial ACOs, and other risk-based arrangements. This role is responsible for designing and leading advanced analytics initiatives that drive performance improvement. This position partners closely with executive leadership, BOI operations, healthcare economics, clinical operations to deliver actionable insights from complex healthcare datasets (claims, EHR, risk adjustment, and attribution data). The Senior Analyst functions as a subject matter expert in value-based risk adjustment and plays a key role in shaping data strategy, reporting architecture, and analytic methodologies. This role requires advanced technical expertise in SQL and Tableau, as well as hands-on experience with modern data platforms including Snowflake, Databricks, DBT, and enterprise data warehouse environments.‎ How will you make an impact & Requirements ‎ Strategic BOI & Risk Adjustment Leadership

• Lead end-to-end analytics supporting Burden of Illness (BOI) strategy across MSSP, Medicare Advantage, Commercial ACOs, and other risk-based contracts.
• Own analysis of risk score performance, suspecting, recapture, and coding accuracy to drive RAF optimization and revenue integrity.
• Identify drivers of variation in risk capture, coding completeness, and disease burden across providers, markets, and populations.
• Partner with executive leadership, clinical, and operational teams to translate insights into actionable risk adjustment and care optimization strategies.
• Serve as a subject matter expert in CMS-HCC, risk adjustment methodologies, BOI frameworks

Advanced Data & Technical Development

• Design, build, and optimize complex SQL queries across integrated datasets including claims, EHR, risk adjustment outputs, quality data, and attribution files.
• Develop scalable data models supporting BOI tracking, RAF performance, suspecting logic, and coding opportunity identification using dbt in Snowflake and/or Databricks.
• Build and maintain data pipelines supporting recurring risk adjustment reporting, provider performance tracking, and executive dashboards.
• Partner with data engineering to enhance EDW structure, data governance, and performance optimization for risk and BOI analytics.

Reporting & Visualization

• Architect and maintain enterprise dashboards in Tableau focused on:

o Risk score (RAF) performance and trend analysis o Suspecting and recapture opportunity tracking o Coding accuracy and provider performance

• Automate recurring reporting to support prospective and retrospective risk adjustment workflows.
• Deliver clear, actionable insights to executive leadership, providers, and operational teams to drive behavior change and performance improvement.

Cross-Functional Collaboration

• Partner with risk adjustment operations, coding teams, clinical leadership, quality, and care management to evaluate intervention effectiveness and close care gaps.
• Support finance and FP&A with RAF projections, revenue forecasting, accruals, and contract performance analytics.
• Support strategic initiatives requiring integrated clinical, financial, and risk-based analysis.

Education and Experience

• Bachelor’s degree in Healthcare Administration, Business, Economics, Data Science, Statistics, or related field required.
• Master’s degree (MBA, MPH, MHA, MS Analytics, or related field) strongly preferred.
• 5–8+ years of progressive experience in healthcare analytics, with at least 3–5 years focused on risk adjustment, BOI analytics, or value-based care.
• Demonstrated experience supporting:

o Medicare Advantage risk adjustment (CMS-HCC) o MSSP / ACO performance and attribution models o Commercial risk arrangements o Suspecting, recapture, and coding optimization programs o RAF forecasting and financial impact modeling o Benchmarking and performance measurement

• Strong experience working with large healthcare claims, EHR, and risk adjustment datasets required.
• Experience in provider organizations, ACOs, payers, or healthcare consulting strongly preferred.

Required Technical Skills

• Advanced SQL (expert-level proficiency required)
• Snowflake (data warehousing and performance optimization)
• Tableau (enterprise dashboard development and visualization)
• Advanced Microsoft Excel
• Deep familiarity with CMS-HCC models, MAO-04 etc

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