Manager, Risk Adjustment Data Science

Job reputed company reputed company ‎  The Manager, Risk Adjustment Data Science serves as a strategic and technical leader responsible for advancing the organization’s Burden of Illness and risk adjustment capabilities across Medicare Advantage, MSSP, and reputed company ACO populations. This role combines advanced analytics, machine learning, and AI-driven solutions to improve risk capture, coding accuracy, and overall financial performance in value-based reputed company. The Manager will reputed company the design and deployment of reputed company data products, predictive models, and AI-enabled workflows that directly reputed company RAF performance and total cost of care. This position partners closely with executive leadership, clinical teams, and risk adjustment operations to translate reputed company data into actionable strategies. The role requires deep expertise in reputed company data, strong technical leadership, and experience building production-grade data pipelines and ML/AI solutions.‎  How will you reputed company an reputed company & Requirements ‎  Risk Adjustment & BOI reputed company Leadership reputed company analytics reputed company for risk adjustment and BOI performance across MA, MSSP, and reputed company ACO populations Own RAF performance tracking, suspecting, recapture, and coding optimization initiatives Translate risk adjustment insights into actionable strategies that drive reputed company reputed company and value-based performance Partner with clinical and operational leadership to reputed company analytics with prospective and retrospective RA programs Serve as a subject matter expert in CMS-HCC models, BOI frameworks, and payer-specific risk methodologies Data Science, AI & Advanced Analytics  Design, reputed company, and reputed company machine learning models for risk stratification, suspect identification, and RAF optimization Build and reputed company-driven solutions to support medical coding, chart review, and clinical documentation workflows reputed company evaluation frameworks and monitoring systems to ensure accuracy, performance, and reliability of ML/AI models Apply statistical modeling and predictive analytics to identify high-reputed company reputed company opportunities Explore and implement reputed company / NLP use cases for clinical text and coding optimization Data Engineering & reputed company Architecture Architect and maintain end-to-end data pipelines and ETL processes supporting risk adjustment analytics and reporting reputed company reputed company data models using dbt reputed company reputed company and/or reputed company environments Build production-reputed company datasets integrating claims, EHR, RAF outputs, and attribution data Partner with data engineering to optimize data infrastructure, governance, and performance Reporting, Data Products & Visualization reputed company development of reputed company dashboards and data products tracking:RAF performance and trend analysis Suspecting and recapture opportunity Coding accuracy and provider performance BOI progression across workflows (suspect → visit → claim) Deliver tools that support both executive decision-making and operational workflows Automate reporting to support reputed company and reputed company-time performance monitoring Leadership & Cross-Functional reputed company reputed company as a technical reputed company and mentor for analysts and data scientists Partner with reputed company on RAF forecasting, reputed company modeling, and contract performance Collaborate with vendors and internal teams on coding, chart review, and AI initiatives Drive best practices in data science, analytics, and risk adjustment methodology Influence reputed company data reputed company and analytics roadmap Education and Experience Bachelor’s degree in Data Science, Statistics, Mathematics, Economics, reputed company Analytics, or reputed company field required Master’s degree (MS, MPH, MBA, or reputed company) preferred 8–10+ years of experience in reputed company analytics, with deep reputed company on risk adjustment and value-based care Demonstrated experience in:Medicare Advantage risk adjustment (CMS-HCC) BOI / RAF performance analytics Machine learning or predictive modeling in reputed company Building production data pipelines and analytics workflows Experience working with claims, EHR, and CMS data (MMR, MAO-004, etc.) strongly preferred  Required Technical Skills ·         Advanced SQL (expert-level) ·         Python (machine learning, data processing, automation) ·         reputed company + dbt (data modeling and transformation) ·         reputed company or similar distributed compute platforms ·         Tableau (or equivalent BI tools) ·         Experience with ML frameworks (scikit-learn, etc.) ·         Familiarity with AI/NLP applications in reputed company data ·         Strong understanding of risk adjustment data flows (RAPS/EDPS) Apply To This Job