TalentoHC is partnered with a healthcare organization actively seeking a Risk Adjustment Analytics Manager to join their team.
The Data Analytics Manager will oversee risk adjustment strategies for Medicare, Medicaid, and Exchange populations, ensuring data accuracy, regulatory compliance, and performance analysis. Responsibilities include refining risk adjustment strategies, coordinating with clinical and operational teams, and responding to CMS requirements.
Key Responsibilities
- Identify and close risk score gaps by monitoring data and care activities.
- Develop provider insights for HCC accuracy, recapture, and submissions.
- Create reports to help physicians improve documentation using EHR and claims data.
- Collaborate with clinicians and operations to enhance outcomes.
- Assess and refine risk adjustment programs based on data analysis.
- Serve as an SME, integrating risk adjustment goals across departments.
- Educate teams on risk adjustment impacts and train on operational dashboards.
- Ensure compliance with CMS and state regulations.
Qualifications
- Bachelor’s degree required; Master’s preferred.
- 5+ years healthcare experience, with 3+ years in risk adjustment.
- Strong understanding of Medicare, CMS-HCC models, and risk scoring.
- Experience analyzing EHR data, claims, and provider documentation.
- Proficiency in SQL, Power BI, and data analytics.
- Effective communicator with cross-functional collaboration skills.
Talento Human Capital Management is an equal opportunity employer people are at the center of what we do! Our organization continues to thrive through our ongoing commitment to building an inclusive and diverse workforce from different backgrounds and perspectives.
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About Talento:
Talento Human Capital Management provides talent and organizational solutions enabling businesses to evolve beyond tactical human resources management. Our footprint spans across the US Latin America and Asia
