Director of Risk Adjustment Analytics

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Santa Monica, CA
$120,000 - $145,000
Job Type
Direct Hire
Nov 20, 2018
Job ID

Nationwide Search for Director of Risk Adjustment Analytics (T-SQL) to oversee the general organization and efficient management of the Medicare Comprehensive Health Assessment Program (CHAPs) data activities for leading healthcare organization. Includes participation in ongoing data mining and analysis, oversight of, development and delivery of education and identification of opportunities to improve reimbursement through proper coding and documentation.
Responsible for the ongoing development, implementation, and facilitation of the processes to assure that all pertinent clinical information impacting the risk scoring of Medicare patients is captured and transmitted to health plans.


  • Designs and manages databases related to RADV (Risk Adjustment Data Validation) and ASM encounter data submission to support efficient and effective processes and utilizes and integrates data warehouse data as appropriate.
  • Generates various analytical reports including return on investment, criteria based member selection and prioritization, and other analytical schedules related to CHAPs activities
  • .Communicate the organization's commitment to superior customer service, including quality, care, and concern with each and every internal and external customer.?
  • Manages teammates working on RADV, Chart review data submission, education, analytics, and general support of corporate Medicare Risk Adjustment activities.
  • Participates in quality assurance of Provider Information Portal (PiP) enhancements and Participates in process improvement projects related to work performed
  • Attends internal team meetings and calls to ensure alignment around project objectives, deliverables, and timelines and performs additional duties as assigned
  • Delivers training to various teammates and other stakeholders with fluency and credibility, facilitating a necessary understanding of key objectives. 
  • Delivers training to various teammates and other stakeholders with fluency and credibility, facilitating a necessary understanding of key objectives.
  • Interprets, provides feedback, and acts as subject matter expert of CMS regulations and reimbursement methodologies.
  • Develops program strategic messaging and communication plans in partnership with Directors and others for each initiative.
  • Analyzes patient and clinician data to monitor performance, validate outcomes, and identify improvement opportunities.
  • Assesses, responds and reacts to CMS and/or internal mandates to ensure compliance and programmatic success.
  • Participates in the development and creation of program training materials (e.g., job aids, presentations, etc.).
  • Reviews CMS documents related to risk adjustment, synthesize findings and formulates recommendations.
  • Functions as the primary content owner of technical and analytic tools utilized for research and analysis
  • Synthesizes complex programs and clearly communicates them to a wide range of stakeholders.
  • Uncovers insights from analyses that can be leveraged strategically, clinically or operationally.


  • Bachelor's degree from a four-year college and/or a professional certification requiring formal education beyond a two-year college. 
  • Master’s degree preferred.



  • Experience in analytics and data analysis
  • Over 5-7 years in a healthcare setting.
  • Over 1-3 years management experience.
  • Experience in Medicare Advantage risk adjustment programs
  • Fluency in Microsoft applications.

Knowledge, Skills, and Abilities:

  • Fluent in T-SQL
  • Demonstrated success working in dynamic, fast-paced environment.
  • Excellent analytical and problem-solving skills.
  • Experience conducting root cause analysis and identifying optimum solutions.
  • Ability to effectively direct preparation of various financial analysis and data mining activities.
  • Excellent verbal and written communication skills.
  • Ability to effectively interface with teammates, clinicians, and management.