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Data Analyst Medicare Risk Adjustment Jobs (NOW HIRING)

Harris Health System

Risk Adjustment Coder II

Houston, TX · On-site

$27.69 - $34.61/hr

... Medicare RADV (Risk Adjustment Data Validation). The Risk Adjustment Coder II will serve as a ... Identify opportunities to improve documentation and coding accuracy; provide analysis and ...

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Data Analyst Medicare Risk Adjustment information

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$34K

$82.6K

$136K

How much do data analyst medicare risk adjustment jobs pay per year?

As of Jun 22, 2026, the average yearly pay for data analyst medicare risk adjustment in the United States is $82,640.00, according to ZipRecruiter salary data. Most workers in this role earn between $62,500.00 and $97,000.00 per year, depending on experience, location, and employer.

How does a Data Analyst in Medicare Risk Adjustment typically collaborate with clinical and actuarial teams?

Data Analysts in Medicare Risk Adjustment often work closely with clinical and actuarial teams to ensure data accuracy and support risk score calculations. They may participate in cross-functional meetings to interpret healthcare data, validate coding accuracy, and discuss trends affecting patient risk profiles. Effective communication is key, as analysts must translate complex data findings into actionable insights for both technical and non-technical stakeholders. This collaboration ensures compliance with CMS guidelines and drives improvements in healthcare quality and reimbursement accuracy.

What does a Data Analyst in Medicare Risk Adjustment do?

A Data Analyst in Medicare Risk Adjustment is responsible for analyzing healthcare claims and patient data to ensure accurate risk adjustment coding and reporting for Medicare Advantage plans. Their work helps health plans receive appropriate payments based on the health status and risk profiles of their members. They use statistical tools and data modeling to identify trends, detect errors, and support compliance with regulatory requirements. Additionally, they often collaborate with clinical and operational teams to improve data quality and support business decisions.

What are the key skills and qualifications needed to thrive as a Data Analyst in Medicare Risk Adjustment, and why are they important?

To thrive as a Data Analyst in Medicare Risk Adjustment, you need strong analytical skills, proficiency in statistics, and a solid understanding of healthcare data, often supported by a degree in a quantitative field. Familiarity with data analysis tools such as SQL, SAS, Python, and experience with risk adjustment models and CMS regulations are typically required. Attention to detail, problem-solving abilities, and effective communication are vital soft skills for interpreting complex data and collaborating with clinical and business teams. These skills ensure accurate analysis, regulatory compliance, and actionable insights that improve healthcare outcomes and drive organizational success.

What is the difference between Data Analyst Medicare Risk Adjustment vs Data Analyst Healthcare Claims Processing?

AspectData Analyst Medicare Risk AdjustmentData Analyst Healthcare Claims Processing
CertificationsRelevant certifications like CPC, RHIT, or RHIA often preferredSimilar certifications, often including CPC or coding certifications
Work EnvironmentHealthcare insurance companies, Medicare Advantage plansHospitals, insurance companies, or healthcare providers
Industry UsagePrimarily in Medicare and government-funded programsAcross various healthcare settings handling claims data

While both roles involve analyzing healthcare data, Data Analyst Medicare Risk Adjustment focuses on optimizing Medicare risk scores and ensuring compliance with Medicare regulations. In contrast, Data Analyst Healthcare Claims Processing centers on managing and analyzing claims data to facilitate accurate billing and reimbursement across healthcare providers.

Associate Director, Risk Adjustment Data and Analytics

Blue Cross and Blue Shield of Massachusetts, Inc.

Boston, MA • On-site

$151K - $184K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 20 days ago

Job description

Ready to help us transform healthcare? Bring your true colors to blue. 

The Role

Director of Risk Adjustment Data and Analytics

Under the direction of the Senior Directory of Medicare Risk Adjustment and Analytics, the Director of Risk Adjustment Data and Analytics is responsible for developing and executing the analytic plan for the Medicare and Merged Market segments. The Director of Risk Adjustment Data and Analytics will oversee the reporting, analytics and management of risk adjustment, internally and externally. The role is responsible for the strategy, execution and performance of Medicare risk adjustment reporting and analytics, infrastructure and systems to meet business objectives, partnership with Actuarial and Provider Contracting, management of external vendors, and compliance with CMS regulations. This leader is responsible for analysis, projections, and assessment of risk adjustment performance.

RESPONSIBILITIES:

  • Responsible for direct leadership of the Risk Adjustment Performance and Strategic Analytics Team and the Risk Adjustment Data and Analytics Team
  • Design and develop metrics, reports, and dashboards to drive key strategic and tactical decisions, ensuring alignment of resources as needed, and balance workloads
  • Coordinate risk adjustment analytics throughout the broader organization
  • Investigate risk adjustment trends across all areas including enrollment, providers and claims to suggest business improvements and efficiencies
  • Represent the Risk Adjustment Team on internal workgroups and committees focused on reporting, analytics, and operations
  • Ensure business deliverables are being met and risk adjustment data is provided to Government Programs leaders and internal business leaders to inform strategic initiatives
  • Act as the primary contact for facilitating resolution (via analysis and reporting) on urgent issues and/or issues escalated by risk adjustment leaders.
  • Drive innovation and improvements through deep dive analytics; improve risk adjustment processes; increase efficiency and productivity and improve overall plan performance
  • Oversee the assessment of reporting requests, compilation, and distribution of routine and ad hoc reports for internal and external constituents
  • Coach, mentor, and develop analytic team members to increase their skill sets, enhance their subject matter knowledge, and improve their effectiveness to support other business areas
  • Oversee submission of BCBSMA's Encounter Data submission to CMS and resolution of errors
  • Represent the Risk Adjustment Team's interests through influence and negotiation in cross-functional workgroups that have a technology focus, are strategic around risk adjustment data and systems, or pertain to new projects.

QUALIFICATIONS:

  • Excellent knowledge of Medicare risk adjustment model
  • Knowledge of Medicare and risk adjustment data and system interfaces required
  • SAS/SQL experience required. Other experience with the use of software for data analysis, extraction, and manipulation (e.g., Python, R), data visualization (e.g., Tableau) and analytic automation (e.g. scripting, macros) preferred
  • Demonstrated attention to detail, delivering quality results and operating collaboratively as part of a team
  • Experience in managing technology-related projects with vendors, IT and corporate partners
  • Proven success in managing people and achieving business goals and objectives
  • Ability to develop strong working relationships and to influence key internal constituents to
  • Documented strength in analysis, identification of problems, and problem resolution
  • Proven track record of meeting timelines, deliverables, attention to detail and quality results
  • Strong organizational skills with ability to work under pressure, multitask and prioritize workload
  • Ability to identify, communicate, and manage risk
  • Effective presentation, facilitation, project management and planning skills

EDUCATION/RELEVANT EXPERIENCE:

  • Bachelor's degree required; Master's degree preferred
  • A minimum of 7 years of Medicare risk adjustment experience
  • Minimum 5 years of progressive leadership experience preferred
  • Project Management and IT experience a plus
  • Must be highly organized and capable of handling a multitude of projects at once
Minimum Education Requirements:

High school degree or equivalent required unless otherwise noted above

LocationBoston, HinghamTime TypeFull timeSalary Range: $151,200.00 - $184,800.00

The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay.

We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

WHY Blue Cross Blue Shield of MA?

We understand that theconfidence gapandimposter syndromecan prevent amazing candidates coming our way, so please don't hesitate to apply. We'd love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It's in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.

As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting ourCompany Culturepage. If this sounds like something you'd like to be a part of, we'd love to hear from you. You can also join ourTalent Communityto stay "in the know" on all things Blue.

At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work" Page.

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