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Manager Hcc Risk Adjustment Jobs in California (NOW HIRING)

Astiva Health

Healthcare Data Analyst

Orange, CA

$85K - $115K/yr

Experience working in Medicare Advantage organizations, MSOs, or managed care settings. * Knowledge of HCC risk adjustment, RAF methodologies, capitation payment model, DOFR, claim processing, bid ...

Urrly

Telehealth Nurse Practitioners

Los Angeles, CA · Remote

$600 - $720/day

Document risk adjustment (HCC coding) during patient visits * Close HEDIS care gaps during visits * Review medical history, medications, and preventive needs * Document visits using ICD-10 and CPT II ...

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Manager Hcc Risk Adjustment information

What is the difference between Manager Hcc Risk Adjustment vs Hcc Risk Adjustment Specialist?

AspectManager Hcc Risk AdjustmentHcc Risk Adjustment Specialist
CredentialsTypically requires a bachelor’s degree, industry certifications (e.g., CPC, CCS), and experience in healthcare or risk adjustmentOften requires similar certifications and experience but may have less managerial responsibility
Work EnvironmentSupervises teams, manages projects, and collaborates with multiple departmentsFocuses on data analysis, coding, and risk adjustment tasks, often working independently or in small teams
Employer & Industry UsageCommonly employed by health plans, healthcare providers, and risk adjustment vendorsFound within similar organizations, often as a specialized role supporting risk adjustment processes

The main difference is that the Manager Hcc Risk Adjustment oversees teams and manages projects, while the Hcc Risk Adjustment Specialist focuses on technical tasks like data analysis and coding. Both roles require relevant certifications and industry experience, but the manager role involves leadership responsibilities.

What are the key skills and qualifications needed to thrive as a Manager HCC Risk Adjustment?

To thrive as a Manager HCC Risk Adjustment, you need expertise in healthcare coding (especially ICD-10), risk adjustment methodologies, and a background in health administration or a related field, often supported by a relevant degree and coding certifications like CRC or CPC. Familiarity with risk adjustment analytics platforms, EHR systems, and healthcare data reporting tools is important. Strong leadership, analytical thinking, and effective communication skills enable you to guide teams and collaborate across departments. These skills and qualifications are essential to ensure accurate risk scoring, regulatory compliance, and optimal reimbursement for healthcare organizations.

How does a Manager HCC Risk Adjustment typically collaborate with other departments to ensure accurate risk scoring?

A Manager HCC Risk Adjustment frequently partners with coding teams, clinical staff, and data analysts to ensure that documentation and coding accurately reflect patient conditions for risk adjustment purposes. This collaboration often involves leading training sessions, reviewing charts for compliance, and coordinating audits to identify documentation gaps. Working closely with these departments helps ensure data integrity, optimize risk scores, and support organizational goals related to reimbursement and quality reporting.

What is a Manager HCC Risk Adjustment?

Manager HCC Risk Adjustment jobs involve overseeing teams and processes that assess and improve Hierarchical Condition Category (HCC) coding and risk adjustment in healthcare organizations. These managers ensure accurate documentation and coding of patient diagnoses to optimize reimbursement and compliance with government regulations. They collaborate with coders, clinicians, and data analysts to monitor performance, provide training, and implement best practices. Their role is critical in maximizing risk-adjusted revenue while maintaining high standards of patient data integrity.
What are the most commonly searched types of Hcc Risk Adjustment jobs in California? The most popular types of Hcc Risk Adjustment jobs in California are:
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Manager Hcc Risk Adjustment jobs near you
Infographic showing various Manager Hcc Risk Adjustment job openings in California as of August 2026, with employment types broken down into 97% Full Time, and 3% Contract. Highlights an 81% In-person, 1% Hybrid, and 18% Remote job distribution.

Healthcare Data Analyst

Astiva Health

Orange, CA

$85K - $115K/yr

Other

Re-posted 19 days ago

Job description

Description

About Us:

Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members.


SUMMARY:

The Healthcare Data Analyst is responsible for analyzing healthcare data to support clinical, operational, and financial decision-making within Medicare Advantage programs. This role focuses on key areas including risk adjustment, quality measures (HEDIS and Star Ratings), pharmacy adherence, and claims analysis. 

The analyst collaborates with clinical, quality, pharmacy, and provider teams to identify trends, monitor program performance, and support CMS regulatory reporting. The role also includes developing automated data workflows and reporting solutions that deliver timely, actionable insights across the organization.


ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:


Data Analysis & Reporting

  • Analyze medical and pharmacy claims, membership, supplement, lab, risk adjustment, and encounter data to support Medicare Advantage quality, risk, and operational programs.
  • Develop and maintain dashboards and reports for HEDIS, Star Ratings, medication adherence, RAF/HCC performance, and EDPS encounter data.
  • Identify trends, care gaps, and performance opportunities to support quality improvement, pharmacy initiatives, and risk adjustment efforts.
  • Provide analytics and reporting to MSOs/IPAs and internal teams, including quality, pharmacy, and risk adjustment.
  • Support regulatory and CMS-related analyses, including encounter data monitoring, claims acceptance, and HCC performance.
  • Deliver consolidated reporting and insights to leadership for strategic decision-making.
  • Examine payments, cost of care, and utilization data to produce metrics for bid submission and JOMs or to address concerns from business partners.
  • Support ad hoc reporting needs across the organization.

Data Quality & Validation

  • Validate and reconcile claims, pharmacy, provider, membership, supplement, and lab data to ensure accuracy and completeness.
  • Investigate and resolve data discrepancies, anomalies, and reporting issues across Medicare Advantage data sources.

Technical & Database Work

  • Write and optimize SQL queries and stored procedures for data extraction, transformation, and analysis.
  • Develop automated ETL workflows and data pipelines to support ongoing reporting needs.
  • Work with large datasets in SQL Server and healthcare analytics platforms.
  • Build dashboards and data visualizations using Power BI or SSRS.
  • Utilize tools such as SQL Server, SSIS, Power BI, SSRS, Python, and Excel.

Collaboration

  • Partner with clinical, pharmacy, quality, enrollment, credentialing, and finance teams to interpret results and support program initiatives.
  • Assist with regulatory and compliance-related reporting requirements.
  • Present findings and insights to both technical and non-technical stakeholders

Requirements

Required Qualifications

  • Bachelor's degree in Data Analytics, Health Informatics, Statistics, Computer Science, or related field.
  • 2-5+ years of healthcare data analytics experience.
  • Knowledge of Medicare Advantage programs, HEDIS, and/or CMS Star Ratings.
  • Advanced SQL skills for querying and analyzing large datasets.
  • Experience with BI tools such as Power BI, SSRS, or similar tools.
  • Strong analytical, problem-solving, and communication skills.

Preferred Qualifications

  • Experience working in Medicare Advantage organizations, MSOs, or managed care settings.
  • Knowledge of HCC risk adjustment, RAF methodologies, capitation payment model, DOFR, claim processing, bid design, and CMS regulatory requirements.
  • Experience analyzing pharmacy adherence metrics (e.g., PDC).
  • Familiarity with EDPS encounter data, claims submissions, and acceptance processes.
  • Experience with ETL tools (e.g., SSIS) or programming languages such as Python or .NET.

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