Principal Risk Adjustment, Revenue Integrity Analytics Lead

Lumeris

. Design, build, and maintain primary analytic assets, dashboards, and reporting for Part C and Part D risk-score performance .

Posted 9/29/2026full-timeRemote • United StatesSenior💰 $133,200 - $180,900 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in healthcare analytics, particularly in Medicare Advantage Part C Risk Adjustment, with a strong focus on data analysis, forecasting, and reporting. Proficient in SQL and dashboard creation, capable of translating complex data into actionable insights for leadership.

Highest-signal resume keywords

Healthcare Analytics ExperienceMedicare Advantage Part C Risk AdjustmentComplex SQL ProficiencyDashboard Development Using Power BI or TableauRisk Adjustment Data Flow Analysis

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data AnalysisForecasting ModelsRisk-Score Performance AnalysisSQLDashboard CreationValidation ControlsAI-Enabled AnalyticsStatistical ToolsFinancial Logic TranslationReconciliation Processes

Soft Skills

Strong Communication SkillsSelf-DirectionAbility to Manage Ambiguity

Tools & Technologies

Power BITableauEDPSMAO-004PDEPythonR

Industry Keywords

Medicare AdvantageRisk AdjustmentCMS-HCCRAFHealthcare AnalyticsFinancial AnalyticsData Quality CriteriaProvider Risk Arrangements

Tech Stack

Tools & technologies

PythonSQLTableau

About the role

Key responsibilities & impact

Design, build, and maintain primary analytic assets, dashboards, and reporting for Part C and Part D risk-score performance
Develop and maintain risk-score and revenue forecasting models, compare projections to actuals, and decompose variances into documented drivers
Trace diagnoses and HCCs from source to payment using submission and response data such as EDPS and MAO-004
Create repeatable reconciliation controls across the diagnosis-to-payment lifecycle
Analyze and track recapture and chart-review recovery opportunities using documented valuation rules
Partner with internal teams to prioritize opportunities and measure performance by provider, program, vendor, and intervention
Automate recurring reporting through scalable dashboards, reusable SQL, documented business logic, and repeatable processes
Own business logic, metric definitions, and data-quality criteria for accurate, reproducible reporting
Translate complex model, coding, and financial logic into decision-ready narratives for leadership and non-technical stakeholders
Monitor Medicare Advantage Risk Adjustment regulatory changes and quantify their impact on data, forecasts, and operations
Serve as analytic truth owner and senior builder/strategic partner to Risk Adjustment, Finance, Actuarial, and other departments
Report directly to the Senior Director of Health Plan Analytics and partner with the VP of Risk Adjustment Solutions and Strategy

Requirements

What you’ll need

Bachelor's degree in a related field such as Mathematics, Statistics, Computer Science, Data Analytics, Health Informatics, Finance, or Actuarial Science
8+ years of healthcare analytics experience, with direct experience in Medicare Advantage Part C Risk Adjustment, RAF, CMS-HCC, and risk-adjusted payment performance
Experience analyzing Part C risk-score performance, including model impacts, coding trends, population mix, and submission outcomes
Experience with Risk Adjustment data flows, including claims/encounters, eligibility, provider data, supplemental files, EDPS, MAO-004, and MMR/payment data
Ability to build and reconcile forecast-to-actual performance across Bid, Budget, projections, and final reconciliation
Hands-on experience writing complex SQL to extract and reconcile data from large-scale data environments
Experience building dashboards and automated reports using tools like Power BI or Tableau
Experience designing validation, QA, and reconciliation controls for high-stakes financial or healthcare analytics
Experience using AI-enabled analytics, automation, or advanced statistical tools to accelerate insight generation
Ability to self-direct analyses, manage ambiguity, and deliver actionable insights with limited direction
Strong communication skills with the ability to explain complex drivers to senior leadership
Advanced degree in Analytics, Economics, Health Informatics, Finance, Actuarial Science, Business Administration, or a related field preferred
Experience with Part D risk-score analytics, PDE, coding/chart-review programs, provider risk arrangements, or using Python/R for advanced analytics preferred
Authorized to work in the United States; visa sponsorship is unavailable

Benefits

Comp & perks

Medical, Vision and Dental Plans
Tax-Advantage Savings Accounts (FSA & HSA)
Life Insurance and Disability Insurance
Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days)
Employee Assistance Program
401k with company match
Employee Resource Groups
Employee Discount Program
Learning and Development Opportunities
Performance-based incentive and/or equity may be available depending on the position
Reasonable accommodations may be made to enable individuals with disabilities to perform essential job duties