Medicare Risk Adjustment Audit Jobs in Edmonds, WA

Amazon Health Services is seeking a Manager, Business Analysis to lead our VBC performance operations analytics team within Medicare Population Health Programs. This leader will own the business reporting cadence, including WBRs, MBRs, and QBRs, and manage a team of business analysts who deliver the insights, forecasts, and models that enable leadership to make informed decisions about our value-based care business.
This role requires deep VBC domain expertise, specifically in Medicare risk adjustment economics, medical claims expense drivers, and membership cohort dynamics. The ideal candidate understands how to translate complex VBC data into clear narratives that drive action, and can build forecasting models that help leadership anticipate performance trajectories across our ACO and MA portfolios.
This person partners closely with our BIE / DE teams as the primary consumer and requirements-setter for data products, ensuring the right data is available, accurate, and translated into business meaning.
Key job responsibilities
Business Operations Cadence
- Own the end-to-end WBR, MBR, and QBR process for VBC performance, including narrative development, variance analysis, and action tracking
- Ensure leadership has clear line of sight into MCER trends, RAF performance, membership retention, and cohort-level economics on a recurring cadence
- Drive deep dives when performance deviates from plan, identifying root causes and recommending corrective actions
- Establish and maintain the metrics framework that defines how we measure VBC success
VBC Performance Insights
- Translate risk adjustment data into actionable insights, including RAF completeness trends, coding opportunity identification, and revenue impact quantification
- Analyze MCE drivers across categories (inpatient, specialty, pharmacy, post-acute) to surface intervention opportunities
- Develop membership analytics including engagement scoring, retention drivers, and cohort economic trajectories
- Quantify the impact of operational programs (care coordination, readmission prevention, specialty network optimization) on financial outcomes
Team Leadership
- Manage and develop a team of business analysts, setting clear expectations for analytical rigor, business acumen, and stakeholder communication
- Build team capabilities in VBC-specific analytics including risk adjustment modeling, claims analysis, and population health measurement
- Establish standards for analytical deliverables, ensuring consistency, accuracy, and actionability
- Create career development paths that grow analysts into VBC domain experts
Cross-Functional Partnership
- Partner with actuary and finance to build maintain membership forecasting models that project cohort growth, attrition, and tenure mix across markets and payers
- Partner with the BIE Manager to define data requirements, validate data quality, and prioritize dashboard and reporting development
- Collaborate with clinical operations, network, and growth teams to ensure analytics support operational decision-making
- Work with finance to align on definitions, methodologies, and reporting standards across VBC financial metrics
- Represent business analytics needs in data architecture and platform planning discussions
About the team
You'll be a key leader on the MPHP team, working at the intersection of clinical operations, technology, and financial performance for One Medical Seniors

The MPHP team supports central strategy, operations and analytics for the One Medical Seniors business line. You will lead a team of 6-7 BAs. This role requires a leader who thrives in ambiguity, brings clarity to complexity, and can align diverse stakeholders around a shared vision.

You'll partner deeply with the MPHP clinical leadership, VBC operations, Product, and BIE/DE teams to drive a top-priority organizational goal: delivering VBC performance and operations insights to better deliver value-based care to our Medicare patients. You'll thrive here if you are energized by high-stakes, high-impact work and are passionate about improving care for Medicare patients at scale.