Lead Director, Healthcare Medicaid Risk Adjustment Analytics

This is a fully remote position, open to applicants in Connecticut, +2 more states.

📋 Description

• Develop and implement the Medicaid risk adjustment strategy across various markets and plans.

• Spearhead and execute high-impact strategic initiatives aimed at enhancing revenue accuracy, compliance, and overall performance.

• Align risk adjustment programs with state Medicaid frameworks (e.g., CDPS, CRG, or specific state methodologies).

• Represent Medicaid risk adjustment informatics in executive-level discussions.

• Monitor health plan performance utilizing advanced analytics and leverage proactive data insights to inform strategies and support evidence-based decision-making.

• Oversee the creation of scalable data pipelines and reporting frameworks utilizing claims, encounters, pharmacy, and clinical data.

• Ensure the accuracy, integrity, and completeness of Medicaid encounter submissions and associated data.

• Establish and manage processes to guarantee the accuracy, completeness, and integrity of risk capture.

• Direct the development of suspecting logic, identification of gaps, and prioritization strategies for operational programs and interventions.

• Lead and nurture a high-performing, multidisciplinary team covering informatics, risk analytics, reporting, and operational program support.

⛳️ Requirements

• 10+ years of experience in healthcare analytics and reporting, including risk adjustment with relevant expertise in claims.

• 3+ years of leadership experience involving management, coaching, or mentoring of team members.

• Advanced technical proficiency in SAS, SQL, Python, or cloud-based analytics platforms (e.g., BigQuery, Snowflake, Databricks, or similar).

• In-depth knowledge of state and regulatory requirements, risk adjustment methodologies, and encounter data processes.

• Strong understanding of risk models (e.g., CDPS, CRG, HCC) and state reconciliation processes.

• Proven track record in developing and executing strategic initiatives that yield measurable business results.

• Demonstrated leadership capabilities in managing cross-functional teams and overseeing large-scale programs.

• Experience with data visualization tools (e.g., Tableau, Power BI, QuickSight, Looker, etc.).

🏝️ Benefits

• Medical, dental, and vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.