Senior Risk Adjustment Analyst
Mosaic Health, LLC., Florida, NY, United States
Senior Risk Adjustment Analyst page is loaded## Senior Risk Adjustment Analystlocations:
Florida, USAtime type:
Full timeposted on:
Posted Todayjob requisition id:
M102963**Job Description Summary**Lead / Senior BOI/Risk Adjustment Analyst serves as a strategic and technical leader supporting the organization’s Burden of Illness (BOI) programs, focusing MSSP ACOs, Medicare Advantage, Commercial ACOs, and other risk-based arrangements. This role is responsible for designing and leading advanced analytics initiatives that drive performance improvement.
This position partners closely with executive leadership, BOI operations, healthcare economics, clinical operations to deliver actionable insights from complex healthcare datasets (claims, EHR, risk adjustment, and attribution data). The Senior Analyst functions as a subject matter expert in value-based risk adjustment and plays a key role in shaping data strategy, reporting architecture, and analytic methodologies.
This role requires advanced technical expertise in SQL and Tableau, as well as hands-on experience with modern data platforms including Snowflake, Databricks, DBT, and enterprise data warehouse environments.**How will you make an impact & Requirements****Strategic BOI & Risk Adjustment Leadership**
• Lead end-to-end analytics supporting Burden of Illness (BOI) strategy across MSSP, Medicare Advantage, Commercial ACOs, and other risk-based contracts.
• Own analysis of risk score performance, suspecting, recapture, and coding accuracy to drive RAF optimization and revenue integrity.
• Identify drivers of variation in risk capture, coding completeness, and disease burden across providers, markets, and populations.
• Partner with executive leadership, clinical, and operational teams to translate insights into actionable risk adjustment and care optimization strategies.
• Serve as a subject matter expert in CMS-HCC, risk adjustment methodologies, BOI frameworks**Advanced Data & Technical Development**
• Design, build, and optimize complex SQL queries across integrated datasets including claims, EHR, risk adjustment outputs, quality data, and attribution files.
• Develop scalable data models supporting BOI tracking, RAF performance, suspecting logic, and coding opportunity identification using dbt in Snowflake and/or Databricks.
• Build and maintain data pipelines supporting recurring risk adjustment reporting, provider performance tracking, and executive dashboards.
• Partner with data engineering to enhance EDW structure, data governance, and performance optimization for risk and BOI analytics.**Reporting & Visualization**
• Architect and maintain enterprise dashboards in Tableau focused on:
o Risk score (RAF) performance and trend analysis
o Suspecting and recapture opportunity tracking
o Coding accuracy and provider performance
• Automate recurring reporting to support prospective and retrospective risk adjustment workflows.
• Deliver clear, actionable insights to executive leadership, providers, and operational teams to drive behavior change and performance improvement.**Cross-Functional Collaboration**
• Partner with risk adjustment operations, coding teams, clinical leadership, quality, and care management to evaluate intervention effectiveness and close care gaps.
• Support finance and FP&A with RAF projections, revenue forecasting, accruals, and contract performance analytics.
• Support strategic initiatives requiring integrated clinical, financial, and risk-based analysis.**Education and Experience**• Bachelor’s degree in Healthcare Administration, Business, Economics, Data Science, Statistics, or related field required.
• Master’s degree (MBA, MPH, MHA, MS Analytics, or related field) strongly preferred.
• 5–8+ years of progressive experience in healthcare analytics, with at least 3–5 years focused on risk adjustment, BOI analytics, or value-based care.
• Demonstrated experience supporting:
o Medicare Advantage risk adjustment (CMS-HCC)
o MSSP / ACO performance and attribution models
o Commercial risk arrangements
o Suspecting, recapture, and coding optimization programs
o RAF forecasting and financial impact modeling
o Benchmarking and performance measurement
• Strong experience working with large healthcare claims, EHR, and risk adjustment datasets required.
• Experience in provider organizations, ACOs, payers, or healthcare consulting strongly preferred.**Required Technical Skills**• Advanced SQL (expert-level proficiency required)
• Snowflake (data warehousing and performance optimization)
• Tableau (enterprise dashboard development and visualization)
• Advanced Microsoft Excel
• Deep familiarity with CMS-HCC models, MAO-04 etcMosaic Health is a national care delivery platform focused on expanding access to comprehensive primary care for consumers with coverage across Commercial, Individual Exchange, Medicare, and Medicaid health plans. The Business Units which comprise Mosaic Health are multi-payer and serve nearly one million consumers across 19 states, providing them with access to high quality primary care, integrated care teams, personalized navigation, expanded digital access, and specialized services for higher-need populations. Through Mosaic Health, health plans and employers have an even stronger care provider partner that delivers affordability and superior experiences for their members and employees, including value-based primary care capacity integrated with digital patient engagement and navigation. Each of the companies within Mosaic Health provide unique offerings that together promise to improve individuals' health and wellbeing, while helping care providers deliver higher quality care. For more information, please visit www.mosaichealth.com.Mosaic Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.If you require an accommodation for the application or interview process, please let us know and we will work with you to meet your needs. Please contact recruiting@mosaichealth.com for assistance.
#J-18808-Ljbffr
Florida, USAtime type:
Full timeposted on:
Posted Todayjob requisition id:
M102963**Job Description Summary**Lead / Senior BOI/Risk Adjustment Analyst serves as a strategic and technical leader supporting the organization’s Burden of Illness (BOI) programs, focusing MSSP ACOs, Medicare Advantage, Commercial ACOs, and other risk-based arrangements. This role is responsible for designing and leading advanced analytics initiatives that drive performance improvement.
This position partners closely with executive leadership, BOI operations, healthcare economics, clinical operations to deliver actionable insights from complex healthcare datasets (claims, EHR, risk adjustment, and attribution data). The Senior Analyst functions as a subject matter expert in value-based risk adjustment and plays a key role in shaping data strategy, reporting architecture, and analytic methodologies.
This role requires advanced technical expertise in SQL and Tableau, as well as hands-on experience with modern data platforms including Snowflake, Databricks, DBT, and enterprise data warehouse environments.**How will you make an impact & Requirements****Strategic BOI & Risk Adjustment Leadership**
• Lead end-to-end analytics supporting Burden of Illness (BOI) strategy across MSSP, Medicare Advantage, Commercial ACOs, and other risk-based contracts.
• Own analysis of risk score performance, suspecting, recapture, and coding accuracy to drive RAF optimization and revenue integrity.
• Identify drivers of variation in risk capture, coding completeness, and disease burden across providers, markets, and populations.
• Partner with executive leadership, clinical, and operational teams to translate insights into actionable risk adjustment and care optimization strategies.
• Serve as a subject matter expert in CMS-HCC, risk adjustment methodologies, BOI frameworks**Advanced Data & Technical Development**
• Design, build, and optimize complex SQL queries across integrated datasets including claims, EHR, risk adjustment outputs, quality data, and attribution files.
• Develop scalable data models supporting BOI tracking, RAF performance, suspecting logic, and coding opportunity identification using dbt in Snowflake and/or Databricks.
• Build and maintain data pipelines supporting recurring risk adjustment reporting, provider performance tracking, and executive dashboards.
• Partner with data engineering to enhance EDW structure, data governance, and performance optimization for risk and BOI analytics.**Reporting & Visualization**
• Architect and maintain enterprise dashboards in Tableau focused on:
o Risk score (RAF) performance and trend analysis
o Suspecting and recapture opportunity tracking
o Coding accuracy and provider performance
• Automate recurring reporting to support prospective and retrospective risk adjustment workflows.
• Deliver clear, actionable insights to executive leadership, providers, and operational teams to drive behavior change and performance improvement.**Cross-Functional Collaboration**
• Partner with risk adjustment operations, coding teams, clinical leadership, quality, and care management to evaluate intervention effectiveness and close care gaps.
• Support finance and FP&A with RAF projections, revenue forecasting, accruals, and contract performance analytics.
• Support strategic initiatives requiring integrated clinical, financial, and risk-based analysis.**Education and Experience**• Bachelor’s degree in Healthcare Administration, Business, Economics, Data Science, Statistics, or related field required.
• Master’s degree (MBA, MPH, MHA, MS Analytics, or related field) strongly preferred.
• 5–8+ years of progressive experience in healthcare analytics, with at least 3–5 years focused on risk adjustment, BOI analytics, or value-based care.
• Demonstrated experience supporting:
o Medicare Advantage risk adjustment (CMS-HCC)
o MSSP / ACO performance and attribution models
o Commercial risk arrangements
o Suspecting, recapture, and coding optimization programs
o RAF forecasting and financial impact modeling
o Benchmarking and performance measurement
• Strong experience working with large healthcare claims, EHR, and risk adjustment datasets required.
• Experience in provider organizations, ACOs, payers, or healthcare consulting strongly preferred.**Required Technical Skills**• Advanced SQL (expert-level proficiency required)
• Snowflake (data warehousing and performance optimization)
• Tableau (enterprise dashboard development and visualization)
• Advanced Microsoft Excel
• Deep familiarity with CMS-HCC models, MAO-04 etcMosaic Health is a national care delivery platform focused on expanding access to comprehensive primary care for consumers with coverage across Commercial, Individual Exchange, Medicare, and Medicaid health plans. The Business Units which comprise Mosaic Health are multi-payer and serve nearly one million consumers across 19 states, providing them with access to high quality primary care, integrated care teams, personalized navigation, expanded digital access, and specialized services for higher-need populations. Through Mosaic Health, health plans and employers have an even stronger care provider partner that delivers affordability and superior experiences for their members and employees, including value-based primary care capacity integrated with digital patient engagement and navigation. Each of the companies within Mosaic Health provide unique offerings that together promise to improve individuals' health and wellbeing, while helping care providers deliver higher quality care. For more information, please visit www.mosaichealth.com.Mosaic Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.If you require an accommodation for the application or interview process, please let us know and we will work with you to meet your needs. Please contact recruiting@mosaichealth.com for assistance.
#J-18808-Ljbffr