{"id":2048293,"url":"https://alion.io/job/advantmed-sr-risk-adjustment-solutions-analyst","title":"Senior Risk Adjustment Solutions Analyst","company":{"id":4282,"name":"Advantmed","domain":"advantmed.com","url":"https://alion.io/company/advantmed","size_band":"201-500","is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"Workable","truth_index":null},"role":"Analytics","role_family":"Analytics","seniority":"senior","employment_type":"full_time","work_mode":"hybrid","remote_scope":null,"remote_scope_basis":null,"remote_working_hours":null,"hiring_geo_confidence":"structured","locations":["United States"],"countries":["US"],"hiring_countries":[],"hiring_countries_total":0,"salary":null,"salary_estimate":{"min_usd":82000,"max_usd":157000,"period":"year","method":"role_seniority_country_remote_cell","sample_n":1721},"experience_years_min":null,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[{"name":"MS SQL","optional":false},{"name":"SQL","optional":false},{"name":"Power BI","optional":true},{"name":"Tableau","optional":true}],"status":"live","first_seen_at":"2026-10-07T20:46:45Z","employer_posted_date":"2026-10-07","last_verified_at":"2026-10-20T01:15:41Z","board_verified":true,"closed_at":null,"days_open":12,"trust":{"level":"ok","repost_count":null,"flags":[],"days_open":12},"description":"ABOUT ADVANTMED\nAdvantmed is a leading provider of risk adjustment, quality improvement, and value-based solutions to health plans and providers. We drive market leading performance with integrated technology, service, and program solutions that improve the risk adjustment and quality programs of our partners. Our solutions focus on identifying, managing, and documenting risk and quality performance, and the proactive clinical engagement of high acuity populations.\nAbout the Role\nWe are seeking a highly motivated and experienced Risk Adjustment Specialist to join our growing Data Analytics team. This role is ideal for a healthcare analytics professional with deep expertise in Medicare Advantage, ACA Risk Adjustment, CMS data, and healthcare analytics.\nThe successful candidate will serve as a trusted subject matter expert, partnering with clients, operations, technology, and leadership teams to transform complex healthcare data into actionable insights that drive Risk Adjustment performance, improve operational efficiency, and support strategic decision-making.\nKey Responsibilities\nRisk Adjustment Analytics & Strategy\nAnalyze Medicare Advantage and ACA Risk Adjustment program performance to identify opportunities for RAF improvement and revenue optimization.\nProvide expertise on CMS-HCC, RxHCC, Medicare Risk Adjustment methodologies, and industry best practices.\nEvaluate operational and financial performance metrics and develop data-driven recommendations.\nSupport client-facing initiatives, business reviews, and executive presentations.\nHealthcare Data Analysis\nAnalyze, cleanse, transform, reconcile, and validate large healthcare datasets from multiple sources.\nPerform analysis across Claims, Encounters, Eligibility, Pharmacy, Medical Record Review (MRR), and Health Assessment datasets.\nIdentify trends, anomalies, and opportunities through detailed data analysis.\nConduct root cause analysis and recommend corrective actions to improve data integrity and operational performance.\nCMS Data Management & Reporting\nWork extensively with CMS data sources, including MMR, MOR, and other Medicare Advantage datasets.\nSupport Risk Adjustment reconciliation, forecasting, and financial impact analysis.\nDevelop operational reports, scorecards, ad hoc analyses, and executive dashboards.\nTranslate complex analytical findings into meaningful business recommendations.\nTechnical & Cross-Functional Collaboration\nDevelop, optimize, and troubleshoot complex SQL queries, stored procedures, and data extraction processes.\nDebug existing reporting and analytical scripts.\nCollaborate with business, operations, technology, and analytics teams to implement scalable solutions.\nSupport automation, process improvement, and operational excellence initiatives.\nRequirements\nEducation\nBachelor's degree in Healthcare, Statistics, Computer Science, Engineering, Business Analytics, or related field.\nExperience\n5+ years of healthcare data analytics experience, including data mining, mapping, transformation, validation, and reporting.\n3+ years of hands-on experience in Medicare Advantage and/or ACA Risk Adjustment.\n3+ years of experience as a Healthcare Data Analyst.\n3+ years of advanced SQL development experience.\nHealthcare & Risk Adjustment Expertise\nStrong understanding of\nMedicare Advantage and ACA Risk Adjustment programs\nCMS-HCC and RxHCC models\nMedical Record Review (MRR) and Health Assessment processes\nClaims, Encounter, Eligibility, and Pharmacy data\nCMS data files, including MMR and MOR\nEnd-to-end Risk Adjustment lifecycle\nHEDIS and healthcare quality measures\nTechnical Skills\nAdvanced SQL and Microsoft SQL Server\nSQL Server Management Studio (SSMS)\nData mapping, reconciliation, and validation\nRoot cause analysis and data quality management\nAd hoc reporting and data extraction\nProfessional Skills\nStrong analytical and problem-solving abilities\nExcellent communication and presentation skills\nExperience working directly with clients and executive stakeholders\nAbility to independently manage multiple priorities in a fast-paced environment\nPreferred Qualifications\nExperience supporting Medicare Advantage health plans, provider groups, or Risk Adjustment vendors.\nExperience with Power BI, Tableau, or other Business Intelligence platforms.\nKnowledge of Risk Adjustment financial forecasting and revenue analytics.\nExperience leading client solutioning discussions and strategic initiatives.\nExposure to automation, process optimization, and operational excellence programs.\nFamiliarity with FHIR, EMR/EHR integrations, and healthcare interoperability standards.\nWhat You'll Bring\nDeep expertise in Risk Adjustment and healthcare analytics.\nAbility to convert complex healthcare data into actionable business insights.\nStrong client-facing and consultative skills.\nA continuous improvement mindset focused on operational excellence and innovation.\nThe ability to work independently while collaborating effectively across teams.\nBenefits\nWhy Join Us?\nThis is an opportunity to make a measurable impact on healthcare outcomes and financial performance by leveraging your expertise in Risk Adjustment, analytics, and strategic consulting. You will work alongside industry experts, solve complex business challenges, and help clients optimize their Risk Adjustment programs through data-driven decision-making.\nIf you are passionate about healthcare analytics, Risk Adjustment, and solving complex problems, we would love to hear from you.\nCompensation for this role will be determined based on the selected candidate's experience and qualifications .\nHealth Care Plan (Medical, Dental & Vision)\nAnnual Performance Bonus\nRetirement Plan (401k, IRA)\nLife Insurance (Basic, Voluntary & AD&D)\nPaid Time Off (Vacation, Sick & Public Holidays)\nFamily Leave (Maternity, Paternity)\nShort Term & Long Term Disability\nWork From Home\nWellness Resources","description_format":"text","description_chars":5878,"description_truncated":false,"requirements":{"experience_years_min":null,"management_years_min":null,"team_size_min":null,"manages_managers":false,"education":{"level":"bachelor","optional":false},"security_clearance":false,"languages":[]},"benefits":["401k plan","Life insurance","Parental leave","Retirement plans"],"hiring_locations":[{"name":"United States","iso":"US","kind":"country"}],"hiring_excludes":[],"relocation_offered":false,"industries":["Care Coordination & Population Health","Revenue Cycle & Medical Billing"],"lifecycle":[{"event":"open","at":"2026-10-07T20:46:45Z"}],"visa":[],"liveness":{"score":86,"band":"hot","label":"Hiring now","p_open":1,"p_active":0.86,"p_room":1,"age_days":11,"expected_fill_days":51,"reasons":["conf:0","win:early"],"computed_at":"2026-10-19T05:45:15Z"},"pay":null,"html_url":"https://alion.io/job/advantmed-sr-risk-adjustment-solutions-analyst","json_url":"https://alion.io/job/advantmed-sr-risk-adjustment-solutions-analyst.json","meta":{"generated_at":"2026-10-20T01:31:23Z","cache_seconds":300,"methodology":"https://alion.io/methodology","terms":"https://alion.io/terms","contact":"https://alion.io/contact","api":"https://alion.io/developers","about":"Alion is a live layer of people, companies and AI agents: who they are, whether they are real and active right now, what they do and how to work with them, readable by people and by agents and paid per call.","catalog":"https://alion.io/catalog.json","usage":{"tier":"crawler_verified","counted_by":"address","units_charged":1,"used_today":1849,"day_limit":null,"remaining_today":null,"minute_limit":300,"resets_at":"2026-10-21T00:00:00Z"}},"offers":[{"id":"company.slices","title":"One company in depth, by slice","status":"live","price":{"credits":0.02,"usd":0.002,"plus_per_slice":{"credits":0.05,"usd":0.005}},"unit":"per company, plus each slice with data","note":"the employer in depth","call":{"mcp_tool":"get_company","arguments":{"id":4282},"rest":"https://alion.io/mcp/rest/get_company?id=4282"},"human":"https://alion.io/catalog?offer=company.slices&for=job%2Fadvantmed-sr-risk-adjustment-solutions-analyst"},{"id":"market.stats","title":"A market slice: pay, demand and time to fill","status":"live","price":{"credits":1,"usd":0.1},"unit":"per slice","note":"pay, demand and time to fill for this role and place","call":{"mcp_tool":"market_stats"},"human":"https://alion.io/catalog?offer=market.stats&for=job%2Fadvantmed-sr-risk-adjustment-solutions-analyst"},{"id":"job.search","title":"Open jobs by role, technology, place, pay and visa","status":"live","price":{"credits":0.02,"usd":0.002},"unit":"per posting in a list","note":"similar open postings","call":{"mcp_tool":"search_jobs"},"human":"https://alion.io/catalog?offer=job.search&for=job%2Fadvantmed-sr-risk-adjustment-solutions-analyst"},{"id":"company.verify","title":"Is this company real and active right now","status":"pilot","price":null,"unit":"per company","request":{"url":"https://alion.io/catalog/request","method":"POST","body":"{\"offer\": \"company.verify\", \"for\": \"job/advantmed-sr-risk-adjustment-solutions-analyst\", \"note\": \"what you need it for\"}"},"human":"https://alion.io/catalog?offer=company.verify&for=job%2Fadvantmed-sr-risk-adjustment-solutions-analyst"}]}