Healthcare Risk Adjustment Analytics (Denver)TechMind RPO • Denver, CO, United States
Healthcare Risk Adjustment Analytics (Denver)
TechMind RPO • Denver, CO, United States
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job_description.job_card.job_description3+ 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. 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.
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 :
Required Skills :
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Risk Adjustment • Denver, CO, United States
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