The Medicare Risk Adjustment team is focused on Encounter Data Systems (EDS), MAO-004 submissions, ACA analytics, and regulatory reporting.
Responsibilities:
Proven success leading cross-functional projects in large-scale healthcare data operations, compliance, data quality, and analytics initiatives.
Expert in end-to-end Risk Adjustment processes, encounter data validation, HCC analytics, provider coding accuracy, CMS reporting, and healthcare data governance. Strong blend of technical expertise and leadership skills with experience driving operational excellence, regulatory compliance, and data-driven decision making.
Required Qualifications- Experienced healthcare analytics professional with 7+ years of healthcare industry experience.
- 5+ years of Medicare Risk Adjustment, EDS, MAO-004, or ACA analytics experience.
- Experience leading projects and healthcare data initiatives.
- Strong knowledge of CMS regulations, HCC models, and regulatory reporting.
Preferred Qualifications- Experience with SQL, SAS, Databricks, Cloud platforms (GCP/Azure/AWS), and Power BI.
- Background in healthcare claims, encounter data, and provider analytics.
- Experience with data governance, automation, and process improvement.
- Master's degree a plus.
Education: Bachelor's degree or rel. work experience.
Anticipated Weekly Hours40
Time TypeFull time
Pay RangeThe typical pay range for this role is:
$66,330.00 - $145,860.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Great benefits for great peopleWe take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 11/04/2026
