Senior Manager, Medicare Risk Adjustment Analytics
Automate your job search with Sonara.
Submit 10x as many applications with less effort than one manual application.1
Reclaim your time by letting our AI handle the grunt work of job searching.
We continuously scan millions of openings to find your top matches.
Overview
Remote
On-site
Compensation
$100,000-$120,000/year
Job Description
Job Overview-Senior Manager, Risk Adjustment Analytics: Our client is seeking a Senior Manager to lead the Revenue Analytics team responsible for CMS risk adjustment analytics. This role drives the financial and strategic aspects of risk adjustment, providing insights to guide executive decision-making. The ideal candidate combines expertise in analytics, finance, and healthcare risk adjustment with the ability to turn data into actionable strategies. 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.
Required Experience:
- 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.
Technical and Functional Skills:
- 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.
Leadership and Behavioral Traits:
- 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.
Education:
- Bachelor's degree required; Master's degree preferred.
Automate your job search with Sonara.
Submit 10x as many applications with less effort than one manual application.
FAQs About Senior Manager, Medicare Risk Adjustment Analytics Jobs at Macpower Digital Assets Edge Private Limited
What is the work location for this position at Macpower Digital Assets Edge Private Limited?
This job at Macpower Digital Assets Edge Private Limited is located in Denver, CO, according to the details provided by the employer. Some roles may also include multiple work locations depending on the requirement.
What pay range can candidates expect for this role at Macpower Digital Assets Edge Private Limited?
Candidates can expect a pay range of $100,000 and $120,000 per year.
What employment applies to this position at Macpower Digital Assets Edge Private Limited?
The employer has not provided this information. This may be discussed during the hiring process.
What is the process to apply for this position at Macpower Digital Assets Edge Private Limited?
You can apply for this role at Macpower Digital Assets Edge Private Limited either through Sonara's automated application system, which helps you submit applications 10X faster with minimal effort, or by applying manually using the direct link on the job page.