Job SummaryThe Principal Risk Adjustment Consultant drives analytical strategies and solutions to optimize Medicare Risk Adjustment (RA) performance. Leveraging deep healthcare expertise and advanced coding proficiency, this role delivers actionable insights, builds dynamic visualizations, and provides strategic advisory services to internal stakeholders and senior leadership.
Core responsibilities include analyses for revenue optimization, risk forecasts, HCC coding logic, RADV audits, Medicare segmentation, data & logic governance. The Principal Risk Adjustment Consultant will build interactive visualizations, interpret CMS model updates that affect organization-wide strategy and risk adjustment analytics and translate highly technical coding, regulatory, and statistical nuances into clear business recommendations for executive leadership
Required Job Qualifications:- Bachelor's degree and 8 years of experience in health care services, statistical analysis, or insurance industry economics or related field OR Master's degree with 6 years of experience in health care services, statistical analysis, or insurance industry economics or related field OR PhD with 4 years of experience in health care services, statistical analysis, or insurance industry economics or related field OR 12 years of experience in health care services, statistical analysis, or insurance industry economics or related field
- Understanding, and being highly proficient at querying a wide variety of internal and external data sources to get meaningful insights.
- Strong analytical skills and proficiency in computer languages, such as SQL, Python, R, etc.
- Ability to create a dynamic and visually engaging dashboard leveraging data visualization tools such as Tableau or Power BI.
- High degree of business intelligence and understanding how to take a business case from inception to customer or partner execution.
- Excellent communication and presentation skills.
- Ability to work independently and as part of a team.
- Ability to lead multiple analytic related projects in parallel.
- Analytics subject matter expert
- Performance excellence in championing initiatives and collaborating with multiple stakeholders to bring the initiative to life.
- Ability to work under pressure and delivery high quality output to senior leadership to decision making within short timeline.
Preferred Job Qualifications: - Deep experience with Medicare Risk Adjustment and Stars.
- Advanced analytics & automation using Alteryx or Airflow for data blending and automation.
- Proficiency with GitHub for collaborative coding and version control.
- Certification or practical experience with project management methodologies and tracking tools (e.g., Agile, Wrike, PMP), and exposure to data science in healthcare including hands-on experience working with predictive models, machine learning pipelines, or Large Language Models (LLMs).
This is a Remote role.#LI-PD1
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Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!Pay Transparency Statement:At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.
The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.
Base Pay Range$102,000.00 - $184,300.00
Exact compensation may vary based on skills, experience, and location.
