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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.

Manager, Risk Adjustment

Central Mass Health LLC

Worcester, MA • On-site

Full-time

Posted 6 days ago

Job description

Description:

Mass Advantage is a Medicare Advantage health plan, located in the heart of Worcester County, headquartered in Worcester MA. Mass Advantage is owned and designed by UMass Memorial Health providers with their patients’ needs in mind.


We are looking for a Manager of Risk Managment to oversee Mass Advantages's full suite of Risk Adjustment activities. This position is responsible for the strategy, execution and performance of Medicare risk adjustment programs, infrastructure and systems to meet business objectives, revenue expectations, management of external vendors, interaction with Providers, regulatory audits, and compliance with CMS regulations. The Manager of Risk Management is also responsible for analysis, projections, and assessment of Medicare revenue initiatives for senior products; leading and coordinating enterprise risk adjustment initiatives, working with the necessary areas of Mass Advantage and UMass Memorial Health Operations as well as vendor partners.


Essential Duties and Responsibilities:

Program Strategy & Execution

  • Own end-to-end RA strategy across prospective (point-of-care capture, suspecting, provider workflows) and retrospective (chart review, coding validation) programs, ensuring complete, accurate, and compliant HCC documentation under the applicable CMS-HCC model (including V24 -V28 transition management).
  • Evaluate current vendor performance, renegotiating or sunsetting SOWs where internal capability is superior.
  • Serve as the plan-side counterpart to UMMH CDI, HIM, and Coding leadership, coordinating with the CMO's office to embed documentation workflows into Epic-based clinical practice rather than layered on top of it.
  • Partner with Network and Clinical Services to design provider-facing education, scorecards, and incentive structures that drive documentation accuracy without creating coding-driven behavior.
  • Develop provider-level performance reporting that is transparent, defensible, and actionable.

RADV, Audit & Compliance

  • Lead RADV audit readiness and response, including medical record retrieval, validation, submission strategy, and cross-functional coordination with Legal, Compliance, and Finance to mitigate financial and compliance risk.
  • Maintain a comprehensive QA program covering RADV, OIG, and internal audits — monitoring the work of internal coders, contracted vendors, and provider documentation alike.
  • Own encounter data integrity, including EDPS submission accuracy, RAPS/EDPS reconciliation, and error resolution.

Analytics, Finance & Bid Support

  • Build and maintain the RA analytics layer — dashboards, KPIs, and provider/member-level reporting that drive continuous improvement in risk score accuracy, coding yield, and program ROI.
  • Partner with Actuarial and Finance on bid development, producing defensible risk score projections, trend analysis, and revenue assumptions grounded in population severity and program performance.
  • Communicate results to executive and board audiences through clear reports, dashboards, and presentations.

Program & Team Leadership

  • Set departmental goals, budgets, and tactical plans aligned with enterprise strategy and financial targets.
  • Other duties may be assigned as needed.

* Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.


Requirements:
  • Bachelor's degree in a relevant field; Master's (MBA, MHA, MPH) preferred.
  • Registered Nurse (RN) desired.
  • CRC (Certified Risk Adjustment Coder), CPC, or CCS certification preferred.
  • 7+ years in Medicare Advantage risk adjustment, with at least 3 years in a plan-side role (not solely provider-side or vendor-side).
  • Direct, hands-on RADV experience - working fluency with the CMS-HCC model, including the V24-V28 transition and its financial implications.
  • Demonstrated experience managing or transitioning RA vendors (coding, chart retrieval, in-home assessment).
  • Strong analytical skills: able to interrogate data directly in SQL, Power BI, or Tableau, or to spec analytics requirements with precision.+
  • Strong Microsoft Office skills (Word, Outlook, Excel and PP).