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Senior Manager, Medicare Risk Adjustment Analytics

Macpower Digital Assets Edge LLC

Denver, CO

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JOB DETAILS
JOB TYPE
Full-time
SKILLS
Analysis Skills, Analytical Development, Claims Processing, Communication Skills, Content Management Systems (CMS), Continuous Improvement, Cross-Functional, Data Quality, Data Warehousing, Entrepreneurship, Finance, Financial Analysis, Financial Operations, Financial Planning, Financial Strategy, Health Economics, Healthcare, Leadership, Legal, Medicare, Mentoring, Operational Audit, Operational Improvement, People Management, Problem Solving Skills, Process Improvement, Regulations, Revenue Analysis, Risk, Risk Analysis, Risk Management, SQL (Structured Query Language), Strategic Planning, Team Building, Team Lead/Manager
LOCATION
Denver, CO
POSTED
30+ days ago
Job Overview-Senior Manager, Risk Adjustment Analytics: Our client is seeking a Senior Manager to lead the Revenue Analytics team responsible for CMS risk adjustment analytics. This role drives the financial and strategic aspects of risk adjustment, providing insights to guide executive decision-making. The ideal candidate combines expertise in analytics, finance, and healthcare risk adjustment with the ability to turn data into actionable strategies. Key Responsibilities: Lead strategic planning and management of risk adjustment accuracy and revenue optimization. Develop and maintain reports analyzing revenue financials and quantifying the impact of initiatives on Medical Loss Ratio (MLR). Write SQL queries to extract, manipulate, and analyze clinical operations, medical claims, and encounter data from data warehouses. Ensure all reporting and analytics comply with evolving CMS regulations and policies. Collaborate with clinical, financial, operational, legal, compliance, and IT teams to enhance risk adjustment precision and data integrity. Serve as a subject matter expert on CMS risk adjustment and maintain up-to-date knowledge of HCC models, regulations, and industry developments. Mentor and manage direct reports to build team capability and support professional development. Present analytical findings and business recommendations to senior leadership. Actively contribute to process improvement and operational excellence initiatives. Required Experience: Minimum 3 years of professional experience with healthcare data, particularly medical claims or encounter data using SQL. Minimum 3 years of experience in healthcare finance, consulting, medical economics, population health, or related analytics roles. At least 1 year of experience with creation, implementation, and measurement of prospective and retrospective risk adjustment programs (CMS RAPS/Encounter submissions). Proven experience managing and developing direct reports. Technical and Functional Skills: Expert knowledge of CMS-HCC models V24 and V28. Strong understanding of the claims data lifecycle, submission systems, and CMS regulations and audits related to risk adjustment. Solid grounding in healthcare economics, value-based care, and population health. Proficiency in SQL and analytics-driven reporting for strategic decision-making. Leadership and Behavioral Traits: Strategic thinker with intellectual curiosity and problem-solving capability. Strong communicator able to translate complex analytics into clear executive insights. Skilled in managing cross-functional partnerships and collaborating at all organizational levels. Highly adaptable and comfortable navigating change and ambiguity. Entrepreneurial and self-motivated with a focus on continuous improvement. Education: Bachelor's degree required; Master's degree preferred.

About the Company

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Macpower Digital Assets Edge LLC