Senior Risk Adjustment Analyst

PacificSource Health Plans

Senior Risk Adjustment Analyst optimizing data submissions to regulatory entities for PacificSource. Collaborating with partners and improving risk adjustment processes and quality improvement.

Posted 7/22/2026full-timeVirginia • 🇺🇸 United StatesSenior💰 $74,601 - $126,823 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in data analytics and risk adjustment, with a strong focus on HEDIS® metrics and regulatory compliance. Proven ability to lead projects, mentor team members, and enhance data integrity through collaboration with technical teams.

Highest-signal resume keywords

Data AnalyticsRisk AdjustmentHEDIS® ExperienceMicrosoft ExcelSAS/SQL

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data SubmissionData ValidationProcess ImprovementProject LeadershipRisk Adjustment DocumentationCoding PracticesNCQA Quality MetricsStatistical AnalysisData Pipeline ImprovementMetrics Reporting

Soft Skills

CollaborationMentorshipCommunicationProblem-SolvingCoordination

Tools & Technologies

Microsoft ExcelSASSQL

Industry Keywords

CMSMedicaidHealth PlanQuality ImprovementRegulatory Compliance

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

Assist in accurate and comprehensive data submission to regulatory entities such as CMS
Collaborate and coordinate with internal and external partners to minimize submission errors
Develop and improve processes related to risk adjustment and quality improvement
Validate data integrity and collaborate with technical teams to improve data pipelines
Report on actionable metrics related to risk adjustment and HEDIS®
Provide mentorship to less experienced team members

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