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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Medicare Advantage and ACA Risk Adjustment methodologies, with a strong focus on data analysis, SQL development, and operational performance improvement. Capable of translating complex data insights into actionable business recommendations while effectively collaborating with cross-functional teams.
Highest-signal resume keywords
Medicare Advantage Risk AdjustmentAdvanced SQL DevelopmentHealthcare Data AnalyticsData Mapping and ValidationRoot Cause Analysis
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Data AnalysisSQL QueriesData TransformationData ValidationData ReconciliationHealthcare Quality MeasuresClaims AnalysisPharmacy Data AnalysisMedical Record ReviewHealth Assessment
Soft Skills
Analytical AbilitiesProblem-SolvingCommunication SkillsPresentation SkillsClient Management
Tools & Technologies
Microsoft SQL ServerSQL Server Management StudioData Extraction ToolsReporting ToolsBusiness Intelligence Tools
Industry Keywords
CMS-HCCRxHCCRisk Adjustment LifecycleHEDISHealthcare Analytics
Tech Stack
Tools & technologiesMS SQL ServerSQL
About the role
Key responsibilities & impact- Analyze Medicare Advantage and ACA Risk Adjustment program performance to identify opportunities for RAF improvement and revenue optimization
- Provide expertise on CMS-HCC, RxHCC, Medicare Risk Adjustment methodologies, and industry best practices
- Evaluate operational and financial performance metrics and develop data-driven recommendations
- Support client-facing initiatives, business reviews, and executive presentations
- Analyze, cleanse, transform, reconcile, and validate large healthcare datasets from multiple sources
- Perform analysis across Claims, Encounters, Eligibility, Pharmacy, Medical Record Review (MRR), and Health Assessment datasets
- Identify trends, anomalies, and opportunities through detailed data analysis
- Conduct root cause analysis and recommend corrective actions to improve data integrity and operational performance
- Work extensively with CMS data sources, including MMR, MOR, and other Medicare Advantage datasets
- Support Risk Adjustment reconciliation, forecasting, and financial impact analysis
- Develop operational reports, scorecards, ad hoc analyses, and executive dashboards
- Translate complex analytical findings into meaningful business recommendations
- Develop, optimize, and troubleshoot complex SQL queries, stored procedures, and data extraction processes
- Debug existing reporting and analytical scripts
- Collaborate with business, operations, technology, and analytics teams to implement scalable solutions
- Support automation, process improvement, and operational excellence initiatives
Requirements
What you’ll need- Bachelor's degree in Healthcare, Statistics, Computer Science, Engineering, Business Analytics, or related field
- 5+ years of healthcare data analytics experience, including data mining, mapping, transformation, validation, and reporting
- 3+ years of hands-on experience in Medicare Advantage and/or ACA Risk Adjustment
- 3+ years of experience as a Healthcare Data Analyst
- 3+ years of advanced SQL development experience
- Strong understanding of Medicare Advantage and ACA Risk Adjustment programs
- Strong understanding of CMS-HCC and RxHCC models
- Strong understanding of Medical Record Review (MRR) and Health Assessment processes
- Strong understanding of Claims, Encounter, Eligibility, and Pharmacy data
- Strong understanding of CMS data files, including MMR and MOR
- Strong understanding of the end-to-end Risk Adjustment lifecycle
- Strong understanding of HEDIS and healthcare quality measures
- Advanced SQL and Microsoft SQL Server
- SQL Server Management Studio (SSMS)
- Data mapping, reconciliation, and validation
- Root cause analysis and data quality management
- Ad hoc reporting and data extraction
- Strong analytical and problem-solving abilities
- Excellent communication and presentation skills
- Experience working directly with clients and executive stakeholders
- Ability to independently manage multiple priorities in a fast-paced environment
Benefits
Comp & perks- Health Care Plan (Medical, Dental & Vision)
- Annual Performance Bonus
- Retirement Plan (401k, IRA)
- Life Insurance (Basic, Voluntary & AD&D)
- Paid Time Off (Vacation, Sick & Public Holidays)
- Family Leave (Maternity, Paternity)
- Short Term & Long Term Disability
- Work From Home
- Wellness Resources