Senior Analytics Consultant
Position Summary:
The Senior Healthcare Analytics Consultant will serve as a subject matter expert in Medicare Advantage risk adjustment, leveraging advanced analytics to optimize revenue accuracy, compliance, and performance. This role requires deep expertise in risk adjustment methodologies, data analysis, and regulatory requirements, combined with strong consulting skills to guide health plan leaders in strategic decision-making. The consultant will lead complex projects, provide actionable insights, and mentor junior analysts to drive organizational success.
Key Responsibilities:
Risk Adjustment Expertise:
- Develop and implement analytic strategies to improve risk score accuracy for Medicare Advantage populations.
- Monitor CMS guidelines and ensure compliance with risk adjustment regulations and data submission requirements.
Advanced Analytics & Modeling:
- Design and execute predictive models to identify coding gaps, forecast revenue, and assess financial impact.
- Analyze encounter data, HCC coding patterns, and member risk profiles to inform interventions.
Consulting & Advisory:
- Partner with health plan leadership to translate analytics into actionable business strategies.
- Provide expert guidance on vendor selection, program design, and operational improvements.
Reporting & Insights:
- Deliver clear, concise reports and presentations to executive stakeholders.
- Communicate complex data findings in a way that drives decision-making and measurable outcomes.
Leadership & Mentorship:
- Lead cross-functional projects and mentor junior analysts in risk adjustment analytics best practices.
- Foster a culture of innovation and continuous improvement within the analytics team.
Qualifications:
Education:
- Bachelor's degree in Statistics, Mathematics, Data Science, Healthcare Administration, or related field; Master's degree preferred.
Experience:
- 5+ years of experience in healthcare analytics with a focus on Medicare Advantage risk adjustment.
- Strong understanding of CMS risk adjustment models (HCC, RxHCC), encounter data, and regulatory requirements.
Skills:
- Proficiency in SQL, SAS, Python, R, or similar analytics tools.
- Expertise in predictive modeling, data visualization, and statistical analysis.
- Excellent communication and consulting skills with ability to influence senior leadership.
Preferred Attributes:
- Experience with vendor management and risk adjustment program oversight.
- Familiarity with machine learning applications in healthcare analytics.
- Strong financial acumen and ability to link analytics to revenue optimization.
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