Senior Data Analyst - ACA Risk Adjustment (Hybrid)

**Resp & Qualifications**

**PURPOSE:**
The purpose of a Sr. Data Analyst is to support ACA risk adjustment processes, including EDGE server analysis and submission validation. Ensure accuracy and integrity of risk adjustment performance metrics through proactive analysis and validation of data sources including claims, enrollment, provider, and EDGE submissions. Analyze and interpret CMS and HHS risk adjustment methodologies to support risk score calculation and financial performance insights.

**ESSENTIAL FUNCTIONS:**

+ Engages in data exploration using various programming languages (reading and writing code), requiring advanced knowledge of multiple database structures. Understand CMS risk score methodology, including risk score calculation, financial risk receivable calculations, EDGE processes and key regulatory deadlines for data submission. Understand the impact of the HCCs on the risk adjustment revenue including interpretation of CMS guidelines, m...