Senior Risk Adjustment Analyst

PacificSource Health Plans

Senior Risk Adjustment Analyst at PacificSource optimizing data submission to regulatory entities. Collaborating with partners to enhance risk adjustment processes and ensuring compliance with healthcare regulations.

Posted 7/22/2026full-timeRemote • Florida • 🇺🇸 United StatesSenior💰 $74,601 - $126,822 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in data analytics and risk adjustment, with a strong focus on data integrity and reporting. Proficient in collaborating with internal and external partners to drive project success in the health plan sector.

Highest-signal resume keywords

Data AnalyticsRisk AdjustmentMicrosoft ExcelSAS/SQLHealth Plan Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data SubmissionRisk ModelsData Integrity ValidationReport DevelopmentData Set MaintenanceRisk Adjustment DocumentationCoding PracticesNCQA Quality MetricsHEDIS ExperienceProject Leadership

Soft Skills

CollaborationCommunicationAnalytical ThinkingProblem SolvingVendor Management

Industry Keywords

Medicaid Risk AdjustmentCMS 5-StarHealth InformaticsMathematicsStatistics

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
Identify, analyze, interpret and communicate risk adjustment trends
Responsible for maintenance of existing reports, development of new reports
Validate data integrity and collaborate with technical teams
Develop and maintain data sets leveraging internal data
Demonstrate mastery in running all applicable risk models
Maintain strict oversight of vendor partners
Assist with all pertinent audits
Develop, maintain, and report action metrics

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 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