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Medicare Advantage Risk Adjustment Analyst Jobs

Hispanic Alliance for Career Enhancement

$100K - $231K/yr

... lead Medicare Advantage and ACA risk adjustment analytics, predictive modeling, intervention ... Lead enterprise risk adjustment analytics supporting risk score completeness, accuracy, engagement ...

Centrum Health

Risk Adjustment Data Analyst

Doral, FL · On-site

ACA, Medicare, ACO REACH, MSSP, and Medicaid. The Risk Adjustment and Quality Analyst will be responsible for working both independently and collaboratively between multiple departments such as ...

Centrum Health

Risk Adjustment Data Analyst

Doral, FL · On-site

ACA, Medicare, ACO REACH, MSSP, and Medicaid. The Risk Adjustment and Quality Analyst will be responsible for working both independently and collaboratively between multiple departments such as ...

Phpmcs

... analytics, healthcare administration, business, or related field (Master's preferred). EXPERIENCE Five (5) to seven (7) years of experience in Medicare Advantage risk adjustment and/or Star Ratings ...

Twin Health

Director, Medicare Advantage Strategy

... management, health equity, risk adjustment, utilization, retention, and plan economics-and ... Deep Medicare Advantage Experience: 10+ years of experience in Medicare Advantage, Medicare ...

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Medicare Advantage Risk Adjustment Analyst information

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$31K

$73.3K

$130K

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

As of Sep 10, 2026, the average yearly pay for medicare advantage risk adjustment analyst in the United States is $73,261.00, according to ZipRecruiter salary data. Most workers in this role earn between $52,500.00 and $87,000.00 per year, depending on experience, location, and employer.

What are popular job titles related to Medicare Advantage Risk Adjustment Analyst jobs?

For Medicare Advantage Risk Adjustment Analyst jobs, the most frequently searched job titles are:

Infographic showing various Medicare Advantage Risk Adjustment Analyst job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 89% Full Time, 8% Part Time, and 2% Contract. Highlights an 85% Physical, 5% Hybrid, and 10% Remote job distribution, with an average salary of $73,261 per year, or $35.2 per hour.

Business Analyst with Risk Adjustment (Payor) || 1099 only || Need USC or GC only

Atlanta, GA • On-site

Pantar Solutions inc
11 - 50 employees
Learn more about Pantar Solutions incexternal

Contractor

Re-posted 8 days ago

Job description

We are an Information Technology and Business Consulting firm specializing in Project-based Solutions and Professional Staffing Services. Please have a look at below position which is with our Client and let me know your interest ASAP. I would really appreciate if you could send me your MOST RECENT UPDATED RESUME: 

Title: Business Analyst – Risk Adjustment (Payor)

Location: Richmond or Atlanta  – Hybrid role

Long Term Contract || 1099 only || Need USC or GC only

Need strong Business Analyst – Risk Adjustment (Payor) with  risk adjustment analytics in a healthcare payer environment (Medicare Advantage, ACA (HIX/Exchange), or Medicaid), SQL, Excel, data visualization tools (Tableau/Power BI/SAS), healthcare data formats (claims, encounters, EMR, lab, and eligibility), regulatory processes (CMS, HHS, EDGE server, RADV/IVA audits), HCC coding models (CMS-HCC, HHS-HCC), ICD-10 codes, and claims data Exp.

Consultant LinkedIn profile must have been created before 2018/2019

Need 8-10+yrs of IT Exp. Profiles

Job Summary:Client is seeking a highly analytical and motivated Business Analyst – Risk Adjustment to support risk adjustment operations and data analytics initiatives. This role is critical in helping ensure accurate and compliant capture of risk adjustment data for government-sponsored programs such as Medicare Advantage and ACA (HIX/Exchange). The candidate will play a key role in translating business needs into technical solutions, driving insights, and enabling optimized risk scoring strategies.
Key Responsibilities:

  • Analyze and interpret risk adjustment data (claims, encounters, chart reviews, HCCs) to identify trends, data quality issues, and improvement opportunities.

  • Collaborate with stakeholders across actuarial, clinical coding, IT, and compliance teams to support risk score accuracy.

  • Translate regulatory and business requirements into user stories or functional specifications for data/reporting solutions.

  • Support CMS/HHS risk adjustment submission processes including EDGE server management and encounter reconciliation.

  • Assist in development and enhancement of dashboards/reports for risk score monitoring, suspecting models, and provider performance.

  • Monitor and interpret changes in CMS/HHS risk adjustment guidelines and apply to internal business processes.

  • Participate in audit support (e.g., RADV, IVA) and validation of risk adjustment data submissions.

  • Act as liaison between technical teams and business stakeholders to ensure delivery of actionable and scalable solutions.

Qualifications:

  • Bachelor's degree in Healthcare Administration, Business, Analytics, or related field (Master’s preferred).

  • 8+ years of experience in risk adjustment analytics in a healthcare payer environment (Medicare Advantage, Medicaid, or ACA).

  • Strong knowledge of HCC models (CMS-HCC, HHS-HCC), ICD-10 coding, and risk adjustment methodologies.

  • Experience with healthcare data formats: claims, encounters, EMR, lab, and eligibility.

  • Proficiency in SQL and Excel; experience with BI tools like Power BI, Tableau, or SAS preferred.

  • Familiarity with regulatory processes (CMS, HHS, EDGE server, RADV/IVA audits).

Preferred Skills:

  • Knowledge of data and reporting tools, including Cognos or Watson Health platforms.

  • Experience in Agile environments; ability to write and manage JIRA user stories and tasks.

  • Strong communication and stakeholder engagement skills across technical and business teams.

 
Thanks & Regards,
 
Babu