Sr Manager, Risk Adjustment Analytics

About The Company

A leading healthcare organization committed to improving patient outcomes through innovative care models and data-driven strategies. The team focuses on risk adjustment accuracy to support value-based care initiatives and ensure regulatory compliance.

Position Overview

This strategic leadership role is responsible for overseeing risk adjustment accuracy within the Integrated Kidney Care (IKC) program. The position requires deep expertise in CMS-HCC models, healthcare economics, and regulatory compliance, along with strong analytical and project management capabilities.

Compensation

• $82k – $121k depending on experience
• Annual performance bonus
• Comprehensive benefits package including medical, dental, vision, and 401(k)
  
  

Key Responsibilities

• Lead and manage the IKC Risk Adjustment Accuracy team, including direct reports.
• Develop and maintain leadership reports on IKC revenue financials and assess the impact of IKC initiatives on Medical Loss Ratio (MLR).
• Write SQL queries to analyze clinical operations and medical claims data.
• Monitor regulatory changes to ensure compliance across all processes and reporting.
• Collaborate with cross-functional teams—clinical, financial, operational, legal, compliance, and IT—to enhance risk adjustment accuracy.
• Serve as a subject matter expert on CMS risk adjustment and stay informed on industry trends.
  
  

Qualifications

• 3 years of experience working with healthcare data, specifically medical claims and/or encounter data using SQL.
• 3 years in healthcare financial management, consulting, medical economics, or population health.
• At least 1 year of experience implementing and evaluating risk adjustment initiatives, including CMS RAPS/Encounter data submissions.
• Proven experience managing and developing direct reports.
• Expert-level knowledge of CMS-HCC models V24 and V28, claims data lifecycle, submission systems, and compliance/audit processes.
• Strong understanding of healthcare economics, population health, and value-based care.
• Excellent communication skills and ability to present complex insights to executive audiences.
• Strategic thinker with intellectual curiosity and strong project management skills.
• Comfortable navigating ambiguity and driving independent improvement initiatives.
• Entrepreneurial mindset with a focus on continuous improvement.
  
  

Equal Opportunity Employer: Associate Staffing is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment based on race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or any other protected status under applicable law. We are committed to creating a diverse and inclusive work environment and welcome applicants from all backgrounds to apply for open positions with our company