Lead Risk Adjustment Analyst, Medicare and Medicaid - Remote Opportunity

Remote - United States

Remote position available

Job Description

Under the supervision of the Director, Risk Adjustment and Clinical Data Science, this individual will be responsible for supporting critical analytic and reporting functions for Enterprise Risk Adjustment including regulatory and risk adjustment submissions to the Centers for Medicare and Medicaid Services (CMS), the Executive Office of Health and Human Services (EOHHS) and other state agencies (e.g., Center for Health Information Analysis etc.). This individual should be exceptionally strong analytically, have an aptitude for problem solving and critical thinking, demonstrate high levels of professionalism, have a willingness to learn and also have strong communication skills to work effectively across business and functional areas. This individual should have the ability to synthesize large data sets and complex information, and have experience working with risk adjustment methodologies applied to Medicare and Medicaid, such as CMS HCC Model and CDPS. This person should demonstrate an ability to follow business processes, to consider options when problems arise and to identify and escalate issues appropriately.

The ideal candidate will have 5+ years of experience in progressively responsible analytical data management roles in a complex operational setting or consulting role. Previous experience working in the health care / health insurance sector either for a health plan, provider group, healthcare IT / management consultancy or auditing firm. Understanding of claims systems and processing, EDGE server submission, EDI files, RAPS, EDPS, RADV, APCD and/or experience working with large data sets, CMS, Medicare Advantage, health insurers and/or medical providers in a technical capacity preferred.

General Job Information


Lead Risk Adjustment Analyst, Medicare and Medicaid - Remote Opportunity



Job Family

Clinical Services Group


United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date


Date Requisition Created


Work Experience

Analytics/Informatics, IT


Bachelors: Computer and Information Science (Required), Bachelors: Mathematics (Required), Masters

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements


  • 5+ years of transact-SQL (MS SQL or Oracle) experience.
  • Experience working with normalized and denormalized data structures.
  • Experience with SAS, SPSS and/or other data mining tools.
  • Demonstrated competency in developing efficient and effective solutions to complex business problems.
  • Experience with healthcare medical and pharmacy claims data manipulation and analysis.
  • Effective listening and communication skills.
  • Ability to work under tight deadlines in a highly dynamic environment.
  • Strong analytic and problem-solving skills and ability to interpret results of query analyses.
  • Ability to develop and communicate analytic results to support business questions; must be capable of translating complex IT and computer concepts to unfamiliar users of the information at the executive level.
  • Expertise in data management and controls, IT processes, and utilizing analytical tools. Comfortable working with large data sets from disparate sources, and able to identify relevant patterns and trends.
  • Expertise in SAS Enterprise Guide/ SAS Base and Proc SQL.
  • Expertise in SQL Server or related SQL language.
  • Proficient in Microsoft Excel, Visual Basic.
  • Experience with R is a plus.
  • Experience with Tableau or Qlik is a plus.
  • Experience developing detailed documentation of policies and procedures.
  • Highly energetic, organized, detail-oriented, resourceful and self-motivated.
  • Must possess maturity, a high degree of professionalism and be able to deal with complexity and uncertainty and/or business decision ambiguity in the face of incomplete information.
  • Strong interpersonal and communication skills with an ability to work collaboratively with both internal and external stakeholders.
  • Must be able to independently manage projects, deliverable timelines, and set expectations with minimal oversight.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

“I receive a high level of support from our Senior Management Team to execute on our vision. They are always accessible and approachable, something I’ve found to be very unique to Magellan.”