Risk Adjustment Specialist (Healthcare Analytics)

Location: United States; fully remote

Company

hirify.global provides risk adjustment, quality improvement, and value-based solutions for health plans and healthcare providers through technology, services, and clinical engagement.

What you will do

• Analyze Medicare Advantage and ACA risk adjustment performance to identify RAF improvement and revenue optimization opportunities.
• Evaluate operational and financial metrics and develop data-driven recommendations for clients and leadership.
• Cleanse, transform, reconcile, and validate Claims, Encounters, Eligibility, Pharmacy, Medical Record Review, and Health Assessment datasets.
• Work with CMS data sources, including MMR and MOR, to support reconciliation, forecasting, financial analysis, and reporting.
• Develop operational reports, scorecards, ad hoc analyses, and executive dashboards.
• Develop, optimize, and troubleshoot SQL queries, stored procedures, data extraction processes, and analytical scripts while collaborating across business, operations, technology, and analytics teams.

Requirements

• Bachelor’s degree in Healthcare, Statistics, Computer Science, Engineering, Business Analytics, or a related field.
• 5+ years of healthcare data analytics experience, including data mining, mapping, transformation, validation, and reporting.
• 3+ years of hands-on Medicare Advantage and/or ACA risk adjustment experience and 3+ years as a Healthcare Data Analyst.
• 3+ years of advanced SQL development experience with Microsoft SQL Server and SQL Server Management Studio.
• Strong knowledge of CMS-HCC, RxHCC, MMR, MOR, the risk adjustment lifecycle, HEDIS, healthcare quality measures, claims, encounters, eligibility, pharmacy, and medical record review data.
• Strong analytical, communication, presentation, client-facing, and prioritization skills.

Nice to have

• Experience with Power BI, Tableau, or other business intelligence platforms.
• Knowledge of risk adjustment financial forecasting and revenue analytics.
• Experience leading client solutioning discussions and strategic initiatives.
• Exposure to automation, process optimization, FHIR, EMR/EHR integrations, and healthcare interoperability standards.

Culture & Benefits

• Fully remote work-from-home arrangement.
• Medical, dental, and vision coverage.
• Annual performance bonus and retirement plans including 401(k) and IRA.
• Paid vacation, sick leave, public holidays, and family leave.
• Life insurance, short- and long-term disability coverage, and wellness resources.