Senior Risk Adjustment Auditor Jobs (NOW HIRING)

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Job Description

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We are seeking ahighly analytical and detail-oriented Senior Risk Adjustment Analystto support our organization'sMedicare Advantage, ACA, and other risk-based programs. This role is critical inreporting, trend analysis, RAF analytics, and provider opportunity targeting. The ideal candidate understandsCMS risk-adjustment methodologies, coding impacts, and can turn data insights into actionable strategies for coding, CDI, and clinical teams. Experience withRADV audits and complianceis preferred.

• Analytics and Insight Generation: Conduct comprehensive analysis of utilization, cost, quantity, and outcomes to uncover drivers, risks, and opportunities and deliver executive-ready insight that inform strategic decisions
• Risk Adjustment and Revenue Integrity (as applicable): Apply risk adjustment methodologies to monitor revenue, generate recurring risk reports, and partner with cross-functional teams to identify and support score-improvement opportunities.
• Data Engineering Lite and Data Quality: Ensure data accuracy and reliability by profiling and reconciling datasets, resolving anomalies, and maintaining documented logic, lineage, and governance standards.
• Reporting and Visualization: Develop and maintain user-friendly dashboards and automated reports, standardizing key metrics and refresh schedules to support leaders and providers.
• Stakeholder Partnership and Communication: Serve as a subject matter expert and translate complex analytical findings into clear, actionable insights for technical and non-technical stakeholders.
• Project Leadership and Mentorship: Lead analytic projects end-to-end and mentor peers by promoting best practices in methodology, coding, documentation, and visualization.
• Compliance, Privacy, and Security: Uphold HIPAA, CMS/State regulations, and governance standards by maintaining compliant, audit-ready processes and documentation.
• Continuous Improvement and Automation: Enhance efficiency through automation, improved data pipelines, and evaluation of emerging tools, including responsible GenAI, to drive productivity and reusability.

Minimum Qualifications

• Bachelor's Degree Statistics, Mathematics, Economics, Data Science, Public Health, Health Informatics or equivalent experience
• 5 years 5+ years of progressive experience in healthcare analytics (payer, provider, or health tech), including hands on work with claims/encounters and membership/enrollment data. and
• Proficiency in SQL and at least one analytics language (Python or R) for data manipulation, analysis, and reproducible workflows.
• Experience building dashboards and reports in applications like Power BI, Tableau, and Qlik.
  Demonstrated ability to structure ambiguous problems, synthesize complex findings, and communicate clearly to executive audiences.
  Experience with Medicare Advantage, Medicaid, and/or Commercial/ACA programs; familiarity with risk adjustment models (e.g., HCC, CDPS+Rx) and quality programs (e.g., HEDIS, Stars).
  Knowledge of provider coding and reimbursement (e.g., CPT, ICD 10, DRG), and managed care operations (UM/CM/DM).
  Exposure to cloud data platforms (e.g., Azure/Synapse/Databricks, Snowflake, BigQuery, or similar) and modern ELT/ETL practices.
  Statistical modeling, forecasting, or predictive analytics experience; A/B testing and causal inference a plus.
  Experience supporting value based care, provider performance analytics, and provider engagement.

Physical Demands
Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.
Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.

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Primary Location Address

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time(including per diemcolleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

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