Lumeris is a physician-first healthcare transformation company dedicated to improving primary care through our AI-powered Primary Care as a Service platform. Backed by Kleiner Perkins.
About the role
The Principal Risk Adjustment & Revenue Integrity Analytics Lead is a senior, hands-on analytics leader responsible for designing, building, validating, and operationalizing Medicare Advantage Part C risk adjustment analytics. Found on 1752vc Careers, the job board for startup and VC roles.
What they're looking for
- Bachelor's degree in a related field such as Mathematics, Statistics, Computer Science, Data Analytics, Health Informatics, Finance, or Actuarial Science
- 8+ years of healthcare analytics experience, with direct experience in Medicare Advantage Part C Risk Adjustment, RAF, CMS-HCC, and risk-adjusted payment performance
- Demonstrated experience analyzing Part C risk-score performance, including model impacts, coding trends, population mix, and submission outcomes
- Experience with Risk Adjustment data flows, including claims/encounters, eligibility, provider data, supplemental files, EDPS, MAO-004, and MMR/payment data
- Ability to build and reconcile forecast-to-actual performance across Bid, Budget, projections, and final reconciliation
- Hands-on experience writing complex SQL to extract and reconcile data from large-scale data environments
More about this role
At Lumeris, we believe that our greatest achievements are made possible by the talent and commitment of our team members. That's why we are actively seeking talented and collaborative individuals who are passionate about making a difference in the healthcare industry. Join us today as we strive to create a system of care that every doctor wants for their own family and become part of a community that values its people and empowers you to make an impact.
We're excited to consider every qualified candidate authorized to work in the United States, although we are unable to sponsor visas for this role at this time.
Principal Risk Adjustment & Revenue Integrity Analytics Lead
The Principal Risk Adjustment & Revenue Integrity Analytics Lead is a senior, hands-on analytics leader responsible for designing, building, validating, and operationalizing Medicare Advantage Part C risk adjustment analytics. Reporting directly to the Senior Director of Health Plan Analytics, this role directly supports the Medicare Advantage plans of Essence Healthcare, serving as the analytic truth owner for Risk Adjustment by connecting risk-score performance, diagnosis and HCC capture, encounter submissions,...
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