Senior Risk Adjustment Analyst

PacificSource Health Plans

Senior Risk Adjustment Analyst focusing on the accurate data submission for Medicare and Medicaid. Collaborating with partners to enhance risk adjustment processes and mentor junior analysts.

Posted 7/3/2026full-timeRemote • Virginia • 🇺🇸 United StatesSenior💰 $74,601 - $126,822 per yearWebsite

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

Assist in the accurate and comprehensive data submission to regulatory entities
Collaborate and coordinate with internal and external partners to minimize submission and response errors
Accumulate and report out on pertinent data sets
Develop and improve processes related to risk adjustment and quality improvement
Maintain required documentation and ensure compliance to all applicable laws, guidance, and regulations
Assume lead role on specified projects
Provide mentorship to less experienced team members
Influence decision making by leadership and provide recommendations regarding potential improvements to risk adjustment processes

Requirements

What you’ll need

Five years’ experience in data analytics or software development required
At least three years’ experience in Health Plan required
In depth risk adjustment and/or HEDIS ® experience required
Expertise in Microsoft Excel and SAS/SQL is required
Experience in leading projects and project teams required
Familiarity with Medicaid risk adjustment and CMS 5-Star required
Familiarity with Risk Adjustment Documentation, Coding practices and NCQA quality metric experience preferred
Bachelor's degree in Mathematics, Statistics, Health Informatics or similar research related field required
Advanced degrees preferred

Benefits

Comp & perks

Flexible telecommute policy
Medical, vision, and dental insurance
Incentive program
Paid time off and holidays
401(k) plan
Volunteer opportunities
Tuition reimbursement and training
Life insurance
Options such as a flexible spending account

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Data SubmissionQuality ImprovementRisk Adjustment DocumentationCoding PracticesNCQA Quality Metrics

Soft Skills

CollaborationMentorshipInfluencing Decision Making