Sr. Director, Risk Adjustment Data & Analytics

Job Overview Sr. Director, Risk Adjustment Data & Analytics (Remote) is a senior technical and operational leader responsible for advancing the integrity, completeness, and strategic value of Medicare Risk Adjustment (MRA) data and analytics programs within the organization. This role serves as the primary accountable leader for MRA data operations — owning the analytical and data engineering infrastructure that enables suspecting, chart review, coding, submission, and reconciliation workflows to operate at scale. Key Responsibilities Lead MRA Data Operations and Ecosystem Quality. Own the end‑to‑end MRA data ecosystem — spanning data ingestion, transformation, validation, reporting and analytics across all Risk Adjustment programs. Ensure data is timely, complete and consistently reliable to support all downstream MRA workflows, from prospective suspecting through CMS submission and reconciliation. Drive Analytical Insights and Program Performance Reporting; develop and maintain reporting and analytical frameworks that explain what happened, why it happened and where to intervene across MRA programs. Translate risk score trends, program impacts and variance drivers into clear, executive‑ready narratives and data visualisations that enable confident decision‑making. Ensure Audit Readiness, Data Governance and Compliance; establish and maintain rigorous data governance standards, controls and documentation to keep MRA data audit‑ready, reproducible and defensible. Partner strategically with Finance, Actuarial and Clinical stakeholders; serve as the primary MRA data partner to Finance and Actuarial teams and support Clinical Operations and JSA Outreach with precise member identification and coding accuracy. Direct and develop the MRA Analytics team; lead a multidisciplinary team of analysts, data scientists and data engineers, promote a culture of quality, and ensure outputs meet technical and operational standards for a regulated environment. Identify and remediate data quality and process gaps; proactively identify gaps in data quality, timeliness or workflow execution and drive corrective actions through system improvements, tooling enhancements or process redesign. Set and enforce technical and analytical standards across all MRA data outputs, including definitions, assumptions and validation checks. Supervisory Responsibilities This role is a people manager responsible for leading the MRA Data & Analytics team, which may include Analysts, Data Scientists and Data Engineers. Accountability for building team capacity, setting performance standards, developing talent, interviewing, hiring and training employees, planning and assigning work, appraising performance, rewarding and disciplining and addressing complaints is required. Experience Required 7–10 years of progressive experience in healthcare data, analytics or data operations, directly supporting Medicare Advantage Risk Adjustment programs. Experience leading or managing data teams in regulated, audit‑sensitive environments. Proven partnership with cross‑functional stakeholders: clinical, finance, actuarial and compliance teams. Ownership of complex, end‑to‑end data pipelines and analytical outputs within a healthcare or regulated industry setting. Experience in a mid‑to‑large enterprise healthcare or health insurance organisation, ideally a Medicare Advantage plan or managed care organisation. Preferred Experience Building or scaling data and analytics functions within a health plan or insurance organisation. Working with chart retrieval vendors and provider partners to coordinate medical records access. Implementing coding and auditing platforms (e.g. Episource, Veradigm, Cotiviti). Education & Certifications Bachelor’s degree in Health Informatics, Data Science, Statistics, Computer Science, Mathematics, Healthcare Administration or related quantitative field; or equivalent combination of education, certification and experience. Preferred: Master’s degree in Data Science, Health Informatics, Biostatistics or related field. Preferred training in data governance frameworks, audit readiness methodologies or advanced analytics (e.g. DAMA, CDMP). Training in Medicare Advantage regulations, CMS reporting requirements, HEDIS, STAR ratings, interoperability and general health plan operations. Skills & Competencies Advanced Medicare Risk Adjustment Operations expertise (HCC coding, ICD‑10 principles, RAF score calculation, CMS encounter data submission, RADV audit requirements). Advanced data analytics and statistical modelling, including translating outcomes into metrics and executive narratives. Proficiency in Power BI, Tableau or equivalent BI platforms; advanced spreadsheet modelling using Excel or Google Sheets. Advanced SQL data querying; familiarity with Python or R is a plus. Advanced cloud and data platform literacy – familiarity with Azure, AWS, GCP, data warehousing solutions and integration with enterprise BI and analytics platforms. No licensure required; preferred certifications include Certified Risk Adjustment Coder (CRC) or Certified Professional Coder (CPC), or equivalent data science/analytics certifications (e.g. CDMP, Databricks, Microsoft Azure Data Fundamentals). Pay Range $198,219.00 – $297,329.00 (may vary by location, education, experience or responsibilities). Equal Opportunity Statement Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, national origin, disability, age, protected veteran status, gender identity or sexual orientation. #J-18808-Ljbffr E2E Alignment Healthcare USA, LLC