MD
Senior Manager, Medicare Risk Adjustment Analytics
Macpower Digital Assets Edge Private Limited
🇺🇸 United States
On-site
Manager or above
5 days ago
$100,000 – $120,000 / year
- CMS
- SQL
- HCC
5 days ago
Key Responsibilities:
- Lead strategic planning and management of risk adjustment accuracy and revenue optimization.
- Develop and maintain reports analyzing revenue financials and quantifying the impact of initiatives on Medical Loss Ratio (MLR).
- Write SQL queries to extract, manipulate, and analyze clinical operations, medical claims, and encounter data from data warehouses.
- Ensure all reporting and analytics comply with evolving CMS regulations and policies.
- Collaborate with clinical, financial, operational, legal, compliance, and IT teams to enhance risk adjustment precision and data integrity.
- Serve as a subject matter expert on CMS risk adjustment and maintain up-to-date knowledge of HCC models, regulations, and industry developments.
- Mentor and manage direct reports to build team capability and support professional development.
- Present analytical findings and business recommendations to senior leadership.
- Actively contribute to process improvement and operational excellence initiatives.
- Minimum 3 years of professional experience with healthcare data, particularly medical claims or encounter data using SQL.
- Minimum 3 years of experience in healthcare finance, consulting, medical economics, population health, or related analytics roles.
- At least 1 year of experience with creation, implementation, and measurement of prospective and retrospective risk adjustment programs (CMS RAPS/Encounter submissions).
- Proven experience managing and developing direct reports.
- Expert knowledge of CMS-HCC models V24 and V28.
- Strong understanding of the claims data lifecycle, submission systems, and CMS regulations and audits related to risk adjustment.
- Solid grounding in healthcare economics, value-based care, and population health.
- Proficiency in SQL and analytics-driven reporting for strategic decision-making.
- Strategic thinker with intellectual curiosity and problem-solving capability.
- Strong communicator able to translate complex analytics into clear executive insights.
- Skilled in managing cross-functional partnerships and collaborating at all organizational levels.
- Highly adaptable and comfortable navigating change and ambiguity.
- Entrepreneurial and self-motivated with a focus on continuous improvement.
- Bachelor's degree required; Master's degree preferred.
Senior Manager, Medicare Risk Adjustment Analytics · Macpower Digital Assets Edge Private Limited