Senior Risk Adjustment Medicare Analyst

Capital Blue Cross • Harrisburg, PA

2d

About The Position

This position partners with the Risk Adjustment leadership team to support risk revenue management initiatives for Medicare and ACA programs. This role contributes to the strategic development and execution of risk adjustment, submission, analytics, and program management activities, with a focus on improving quality of care, optimizing revenue, strengthening analytical capabilities, and ensuring ethical, compliant, and audit-ready practices.

Requirements

• Experience creating detailed reports and communicate complex data structures.
• Possess high level of interpersonal skills.
• Strong problem-solving skills with the ability to think critically and provide data driven solutions.
• Ability to adapt to changing priorities of multiple customers.
• Advanced proficiency with SQL query techniques and exposure to business intelligence tools with advanced proficiency in SAS, Power BI, and Snowflake.
• Advanced skills in Microsoft Excel.
• Deep understanding of and experience in Risk Adjustment (MA & ACA) business analytics with knowledge of different risk models including HCC, RxHCC, HHS-HCC and CDPS,
• Knowledge of Healthcare Plan systems, applications, databases and their underlying data structures, including but not limited to: claims, eligibility, provider.
• 5 years' experience in data analysis, database technologies (Snowflake, SAS), SQL queries, etc.
• Experience analyzing risk adjustment data for trends, disease/diagnosis prevalence and condition hierarchy.
• Bachelor's Degree in Analytics, Information Systems, or related field or 9 years of relevant experience in lieu of degree.
• While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see.
• The employee must be able to work over 40 hours per week.
• employee must occasionally lift and/or move up to 5 pounds.

Nice To Haves

• Foundational knowledge of predictive modeling and statistical analysis techniques.
• Prefer experience with advanced analytics tools and programming languages, such as Python.
• Experience designing, building, and maintaining databases or analytical data structures.

Responsibilities

• Analyze large datasets to identify trends, patterns, and insights related to coding output, with a focus on improving quality.
• Take ownership of complex data workflows by building and maintaining scalable analytics pipelines using data tools such as SQL, SAS, and Snowflake.
• Leverage technical expertise to streamline recurring and/or ad-hoc analyses into reusable, scalable data products.
• Collect, interpret, and aggregate data from multiple sources to support risk adjustment, medical record coding, government audits, and quality initiatives.
• This position supports the development of risk-related policies, procedures, and governance strategies, identifies opportunities to improve processes and efficiency, and delivers actionable insights through enterprise reporting and analytics tools such as SQL, SAS, Snowflake, and Power BI.

Benefits

• Medical, Dental & Vision coverage
• Retirement Plan
• generous time off including Paid Time Off, Holidays, and Volunteer time off
• Incentive Plan
• Tuition Reimbursement

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level