Title: Sr. Manager, Risk Adjustment Analytics
Location: Denver, CO (Onsite)

Job Description: We are seeking a Senior Manager, Risk Adjustment Analytics to join the Integrated Kidney Care (IKC) Revenue Analytics team, responsible for all CMS risk adjustment-related analytics. This role will lead the financial and strategic aspects of risk adjustment, providing actionable insights that guide executive-level decision-making. The ideal candidate will have a strong background in analytics, finance, and risk adjustment, with the ability to translate complex data into strategic recommendations.

This is an exciting opportunity to shape the direction of risk adjustment analytics within a dynamic and growing organization that manages end-to-end kidney care and complex chronic condition management across the U.S.

Essential Responsibilities

• Provide strategic leadership and management for the IKC Risk Adjustment Accuracy.

• Create and maintain leadership reports on IKC revenue financials and estimate the impact of IKC initiatives on Medical Loss Ratio (MLR).

• Write SQL queries against data warehouses containing clinical operations and medical claims data to support analytic requests and deliver insights to stakeholders.

• Monitor evolving regulations and policies to ensure all processes and reporting meet compliance requirements.

• Partner with clinical, financial, operational, legal, compliance, and IT teams to improve risk adjustment accuracy.

• Serve as a subject matter expert on CMS risk adjustment and stay current on industry trends.

• Perform other duties as assigned.

Required Experience

• 3+ years of professional experience with healthcare data, specifically medical claims and/or encounter data using SQL.

• 3+ years of experience in healthcare financial management, healthcare consulting, medical economics, population health, or a similar area.

• Minimum 1 year of experience in creation, implementation, and impact estimation of prospective and retrospective risk adjustment initiatives, including CMS RAPS/Encounter data submissions.

• Experience developing and managing direct reports.

Skills & Knowledge

• Expert-level knowledge of CMS-HCC models V24 and V28, claims data lifecycle, submission systems, regulations, compliance, and audits related to risk adjustment.

• Strong understanding of healthcare economics, population health, and value-based care.

• Proven ability to work collaboratively across cross-functional teams and communicate effectively at all organizational levels.

• Skilled at presenting complex analysis and insights to executive audiences.

• Demonstrated intellectual curiosity, strategic thinking, and project management skills.

• Comfortable with ambiguity and adapting to change.

• Entrepreneurial mindset with the drive to continuously improve and deliver results independently.

Years of Experience:

• 3+ years with healthcare data (claims/encounter data using SQL)

• 3+ years in healthcare financial management, consulting, medical economics, or population health

• 1+ year in CMS risk adjustment initiatives (RAPS/Encounter submissions)

• Leadership experience managing direct reports

 
 
At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $ 82000.00/Yearly.