Senior Data Analyst, Risk Adjustment

Role overview

Senior Data Analyst focused on Risk Adjustment for a healthcare environment. The role sits at the intersection of healthcare data, engineering, and operations, ensuring the accuracy and integrity of risk adjustment and encounter data—especially for CMS submission workflows—to support revenue accuracy, compliance, and patient outcomes.

Responsibilities

• Ensure the reliability and accuracy of risk adjustment data processes, with ownership of CMS encounter and supplemental submission workflows.
• Monitor and manage end-to-end data flows for CMS Encounter Data System (EDS) submissions to vendors and government agencies.
• Own claim and supplemental submission workflows, ensuring accuracy, completeness, and regulatory compliance.
• Build and maintain data pipeline tracking reports to identify, analyze, and resolve encounter data errors.
• Collaborate with Engineering and Risk Adjustment teams to improve data integrity and operational performance.
• Support risk adjustment initiatives by tracking and optimizing data-driven strategies.
• Develop and maintain dashboards and reporting tools for operational visibility and decision-making.
• Create and update documentation, policies, and procedures for encounter data processes and governance.

Requirements

• 2+ years experience in Medicare Risk Adjustment and CMS EDS submissions.
• 2+ years experience working with healthcare claims data in an analytical or operational role.
• Strong programming skills in SQL, Python, and/or R for analysis and automation.
• Experience building operational dashboards and reporting solutions.
• Strong understanding of data pipelines, data quality monitoring, and error resolution processes.
• Ability to work independently, take ownership of complex workflows, and deliver high-quality results.
• Strong communication skills across technical and non-technical teams.

Nice to have

• None explicitly stated beyond the requirements and domain expertise described.