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, monitoring and determining the impact of any changes to the HCC model and supporting actuarial in the calculation risk adjustment revenue. * Collect, analyze, and interpret data to glean insights, and develop business appropriate recommendations. * Assists in designing an overall suite of analytic capabilities and actionable reports to solve problems, provide data\-driven guidance, and monitor risk adjustment performance. Provide analytical support on various strategies to ensure organizational goals are met and propose opportunities in maximizing reimbursement based on the CMS\-HCC (Hierarchical Condition Code) model. Perform data mining of claims and data to identify trends, data issues and members with missing HCCs. * Research and analyze data flow across complex data ecosystem including operational and analytical data platforms. * Serve as an expert resource supporting data questions and issues from stakeholders and driving to resolution. Collaborate across business units to coordinate the developmen