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Senior Risk Adjustment Data Analyst - Remote

Sentara
life insurance, paid time off, sick time, tuition assistance, 401(k), 403(b), remote work
United States, Virginia, Virginia Beach
Jun 04, 2025
City/State Richmond, VA Work Shift First (Days) Overview: Sentara Health is looking for a Senior Risk Adjustment Data Analyst to join our team! This position is 100% Remote, but candidates must have a current residence in one of the following East Coast states, or be willing to relocate: Delaware, Florida, Georgia, Maine, Maryland, New Hampshire, North Carolina, Pennsylvania, South Carolina, Virginia , West Virginia The Senior Risk Adjustment Data Analyst provides data analysis supports to Sentara Health Plans' Revenue Management team, affiliated internal departments, and external vendor partners. The Senor RA Analyst supports in designing and implementing processes and solutions utilizing a wide variety of data sets to resolve business challenges in relation to optimizing Risk Adjustment premium revenue. The senior analyst uses a combinations of data/text mining, analysis, reporting, predictive and risk modeling to support informed business decisions. This requires complete understanding of claims, pharmacy, lab, network utilization, and cost containment data. Additionally, familiarity with external data sources including Medicare, Medicaid, and Health Exchange data files is required. The Senior RA Data Analyst is required to show independent thinking. The senior analyst assists in identifying business challenges, support development of processes to address the challenges, and metrics to track and monitor business processes. This requires a high level of understanding of Centers for Medicare and Medicaid (CMS), Health and Human Services (HHS), or Virginia Department of Medical Assistance (VA-DMAS) Risk Adjustment programs. The Senior RA Data Analyst must Serve as SME for standard analytic suites using EDP data sources for membership data and claims. Create and manage tables in the revenue management sandbox. Design table layouts and collaborate with the enterprise data team to develop new tables. Partner with architecture teams to build new and necessary data sources. Project Involvement: Collaborate with vendors on risk adjustment initiatives. Created necessary reports for business and regulatory use. Automated existing reports to improve efficiency. Developed and maintained dashboards for data visualization. Education Bachelor's Degree in Mathematics, Statistics, Finance, Economics, Computer Science, or related Certification/Licensure No specific certification or licensure requirements Experience 3 - 5 years in data analysis, predictive modeling, Medical Economics or related Advanced Knowledge of SQL AND databricks is required. Ability to break out complex technical processes and explain to non-technical audiences Understanding of Prospective and Retrospective Risk Adjustment Interventions preferred Excellent Oral and Written Communication Skills Problem Solving Consultative Engagement Skills Keywords: Risk adjustment , SQL, Databricks, claims We provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay rate for Full Time employment is: $60,756 - $101,254. Additional compensation may be available for this role such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Benefits: Caring For Your Family and Your Career * Medical, Dental, Vision plans * Adoption, Fertility and Surrogacy Reimbursement up to $10,000 * Paid Time Off and Sick Leave * Paid Parental & Family Caregiver Leave * Emergency Backup Care * Long-Term, Short-Term Disability, and Critical Illness plans * Life Insurance * 401k/403B with Employer Match * Tuition Assistance - $5,250/year and discounted educational opportunities through Guild Education * Student Debt Pay Down - $10,000 * Reimbursement for certifications and free access to complete CEUs and professional development Pet Insurance Legal Resources Plan Colleagues have the opportunity to earn an annual discretionary bonus ifestablished system and employee eligibility criteria is met. Sentara Health is an equal opportunity employer* and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves. In support of our mission "to improve health every day," this is a tobacco-free environment. For positions that are available as remote work, Sentara Health employs associates in the following states: Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.