Offer summary

Qualifications:

Bachelor's degree in Actuarial Science, Math, Statistics, or related fields., 5–7 years of experience analyzing and interpreting Risk Adjustment data and models., Expertise in healthcare industry with a focus on Risk Adjustment and familiarity with MA/ACA Risk Scoring methodologies., Advanced knowledge of SAS, SQL, and Snowflake is preferred..

Key responsabilities:

Develop analytics and data products related to Risk Adjustment for Medicare Advantage, ACA, and Medicaid.

Lead customer-focused initiatives, including ad hoc reporting and research requests.

Conduct research and recommend enhancements to internal algorithm performance.

Provide training and guidance on the Risk Adjustment process to internal and external teams.

Job description

Welcome to Veradigm, where our Mission is transforming health, insightfully. Join the Veradigm team and help solve many of today’s healthcare challenges being addressed by biopharma, health plans, healthcare providers, health technology partners, and the patients they serve. At Veradigm, our primary focus is on harnessing the power of research, analytics, and artificial intelligence (AI) to develop scalable data-driven solutions that bring significant value to all healthcare stakeholders. Together, we can transform healthcare and enable smarter care for millions of people.

Are you passionate about driving impactful change in healthcare? Do you thrive in a collaborative and detail-oriented environment? Are you an avid problem solver with exceptional technical skills? Are you typically considered a healthcare analytics expert? Are you driven to make change in Risk Adjustment outcomes? Are you looking for an environment where innovation is key?

If your answer is "Yes!" to these questions, we may have the perfect role for you!

Job Summary

As our Expert Risk Adjustment Analyst, you'll play a pivotal role as a subject-matter expert specializing in Medicare Advantage, Affordable Care Act (ACA), Medicaid, and Accountable Care Organization (ACO) Risk Adjustment. You'll develop analytics and data products, create financial calculations and projections, and address customer inquiries about risk adjustment performance.

Essential Functions

Craft business cases and requirements for new and improved products to advance customers' Risk Adjustment goals, collaborating closely with software developers.
Lead customer-focused initiatives, including ad hoc reporting and research requests.
Own customer financial improvement modeling (e.g., Mid-Year Payment, Final Year Payment, Transfer Payment).
Conduct research and recommend enhancements to internal algorithm performance.
Partner with clinicians to refine outcomes, algorithm performance, and product development.
Provide in-depth training and guidance to both internal and external teams on all facets of the Risk Adjustment process.
Stay informed about CMS regulations and offer expert interpretations to customers and product teams.

Job Requirements

Bachelor's degree in Actuarial Science, Math, Statistics, or related fields.
5–7 years of experience analyzing and interpreting Risk Adjustment data and models (Medicare Advantage, ACA, or Medicaid).
Proven ability to develop scalable analytic and reporting solutions.

Knowledge, Skills, and Abilities

Expertise in the healthcare industry with a focus on Risk Adjustment.
Familiarity with MA/ACA Risk Scoring methodologies, including condition categories (HCC, RxHCC, etc.).
Experience with actuarial or financial modeling concepts and large healthcare datasets (e.g., CMS files like MMR, MOR, MAO-004).
Advanced knowledge of SAS, SQL, and Snowflake (preferred).
Strong written and verbal communication skills paired with exceptional interpersonal abilities.
Curiosity, initiative, and attention to detail, with a team-oriented mindset

THIS IS A REMOTE POSITION

Enhancing Lives and Building Careers

Veradigm believes in empowering our associates with the tools and flexibility to bring the best version of themselves to work and to further their professional development. Together, we are In the Network. Interested in learning more?

Take a look at our Culture, Benefits, Early Talent Program, and Additional Openings.

We strongly advocate that our associates receive all CDC recommended vaccinations in prevention of COVID-19.

Visa Sponsorship is not offered for this position.

At Veradigm, our greatest strength comes from bringing together talented people with diverse perspectives to support the needs of healthcare providers, life science companies, health plans, and the patients they serve. The Veradigm Network is a dynamic, open community of solutions, external partners, and cutting-edge artificial intelligence technologies that provide advanced insights, technology, and data-driven solutions. Veradigm offers a comprehensive compensation and benefits package, including holidays, vacation, medical, dental, and vision insurance, company paid life insurance and retirement savings.

Veradigm’s policy is to provide equal employment opportunity and affirmative action in all of its employment practices without regard to race, color, religion, sex, national origin, ancestry, marital status, protected veteran status, age, individuals with disabilities, sexual orientation or gender identity or expression or any other legally protected category. Applicants for North American based positions with Veradigm must be legally authorized to work in the United States or Canada. Verification of employment eligibility will be required as a condition of hire. Veradigm is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse and inclusive workforce.

From a "VEVRAA Federal Contractor" We request Priority Referral of Protected Veterans

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