Sr. Analyst, Risk Adjustment (0779)

Why Join CINQCARE?

CINQCARE is a provider-led, community-based health and care partner dedicated to improving the health and well-being of those who need care the most, with a deep commitment to high-needs, urban and rural communities. Our local physicians, nurses, and caregivers work together to serve people and the communities they live in, beyond just treating symptoms. We remove barriers by delivering personalized care as close to home as possible, often in-home, because we know a deep understanding of our patient’s race, culture, and environment is critical to delivering improved health outcomes. By empowering patients, providers, and caregivers with the support they need, we strive to make health and care a reality—not a burden—every single day. Join us in creating a better way to care.

Position Overview

The Sr. Risk Adjustment Analyst is a high-impact individual contributor on CINQCARE's risk adjustment team, reporting directly to the Sr. Director of Risk Adjustment. This role is responsible for conducting advanced data analysis, building and maintaining HCC performance reporting, and supporting predictive modeling initiatives that drive risk score accuracy and reimbursement optimization across Medicare Advantage, Medicaid Managed Care, and ACO REACH programs. The Sr. Analyst serves as a key analytical resource, translating complex data into actionable insights for both clinical and operational stakeholders.

Key Responsibilities

• Design, develop, and maintain risk adjustment performance dashboards and reports using Power BI, Tableau, or equivalent tools to monitor HCC capture rates, RAF score trends, and coding completeness.
• Conduct in-depth analysis of claims, encounter, and clinical data to identify HCC coding gaps, suspecting opportunities, and areas for improvement in documentation completeness.
• Write and optimize complex SQL queries to extract, transform, and analyze large datasets from data warehouses and payer/provider data systems.
• Support the development and validation of predictive models for HCC suspecting, risk score forecasting, and provider performance stratification.
• Prepare and present analytical findings, trend analyses, and performance summaries to the Sr. Director and cross-functional leadership teams.
• Collaborate with clinical, provider engagement, and coding teams to translate data insights into targeted interventions and outreach strategies.
• Perform retrospective and prospective data analysis to assess the impact of chart review programs, coding initiatives, and CDI efforts on overall risk scores.
• Monitor CMS-HCC, HHS-HCC, and CDPS model updates and assess their impact on organizational risk adjustment performance and strategy.
• Assist with audit-readiness by maintaining documentation, data integrity checks, and compliance with CMS guidelines and ICD-10 coding standards.
• Mentor junior analysts and coordinators, providing guidance on analytical methods, data interpretation, and risk adjustment concepts.
• Support cross-functional initiatives in quality, population health, and finance as they relate to risk adjustment analytics.

Required Qualifications

Education:

• Bachelor's degree in data science, Mathematics, Statistics, Health Informatics, Public Health, or a related quantitative field.

Experience:

• 4-6 years of experience in risk adjustment analytics, health plan analytics, or a closely related role.
• Experience in a value-based care, ACO, or managed care setting (preferred).

Certifications:

• Certified Risk Adjustment Coder (CRC) or Certified Professional Coder (CPC) is a plus.

Technical Skills:

• Strong proficiency in SQL; ability to write complex queries for data extraction, transformation, and analysis.
• Hands-on experience with data visualization tools (Power BI, Tableau, or similar) to build production-quality dashboards and reports.
• Solid understanding of CMS-HCC, HHS-HCC, and/or CDPS risk adjustment models, ICD-10 coding, and encounter data.
• Experience working with large, complex datasets including claims data, encounter data, and clinical/EMR data.
• Proficiency in Python or R for statistical analysis and data wrangling (preferred).
• Familiarity with cloud data platforms (Snowflake, Databricks, Redshift, or similar).

Soft Skills:

• Excellent written and verbal communication skills; ability to explain complex analytical findings to non-technical audiences.

The working environment and physical requirements of the job include:

In-office work is performed indoors in a traditional office setting with conditioned air, artificial light, and an open workspace.

In this position you will need an to communicate with customers, vendors, management, and other co-workers in person and over devices, sometimes with people who are agitated. Regular use of the telephone and e-mail for communication is essential. Sitting for extended periods is common. Must be able to receive ordinary information and to prepare or inspect documents. Lifting of up to 10 lbs. occasionally may be required. Good manual dexterity for the use of common office equipment such as computer terminals, calculator, copiers, and FAX machines. Good reasoning ability is important. Able to understand and utilize management reports, memos, and other documents to conduct business.

Equal Opportunity & Reasonable Accommodation Statement

CINQCARE is an Equal Opportunity Employer committed to creating an inclusive environment for all employees. We provide equal employment opportunities to all individuals regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected characteristic under applicable law.

If you require a reasonable accommodation during the application or employment process, please indicate this in your application or speak with your recruiter during the hiring process.

Disclaimer

This job description is intended to describe the general nature and level of work being performed. It is not intended to be an exhaustive list of all responsibilities, duties, and skills required. Management reserves the right to modify, add, or remove duties as necessary.

Our Benefits

At CINQCARE, we care for our team like we care for our patients—holistically. We offer flexible, comprehensive benefits so you can thrive while delivering top-notch care.

• Medical Plans: Two comprehensive options offered to Team members.
• 401K: 4% employer match for your future.
• Dental & Vision: Flexible plans with in-network savings.
• Paid Time Off: Generous PTO, holidays, and wellness time.
• Extras: Pet insurance, commuter benefits, mileage reimbursement, CME for providers, and company-provided phones for field staff.