
location_onRemote
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
The Sr. Director, Risk Adjustment Data & Analytics 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.
Working cross-functionally with MRA Business leadership, Finance, Actuarial, Clinical Operations, Compliance, and enterprise IT teams, this leader ensures that all key stakeholders are working from consistent, trusted, and defensible MRA data. The role leads a multidisciplinary team of analysts, data scientists, and data engineers, setting analytical standards and translating program outcomes into clear, actionable insights for senior leadership.
This role is critical to the organization because Risk Adjustment Factor (RAF) scores directly drive plan revenue, making accurate, timely, and defensible MRA data a high-stakes organizational priority. As the operational owner of this capability, you will drive the culture of quality and continuous improvement necessary to navigate a highly regulated environment.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.
Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam, please report the incident to the Federal Trade Commission. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health's talent acquisition team, please email careers@ahcusa.com.
Skills: Medicare Risk Adjustment, HCC Coding, Icd-10 Coding, Raf Score Calculation, CMS Encounter Data Submission, Radv Audit, Data Analytics, Statistical Modeling, Power Bi, Tableau.
Education: Bachelor's degree in quantitative field or equivalent combination of education, certification, and experience; Master's degree in Data Science, Health Informatics, Biostatistics, or related field.
Work model: Remote
Remote
Experience building or scaling data and analytics functions within a health plan or insurance organization. Experience working with chart retrieval vendors and provider partners to coordinate medical records access. Experience implementing coding and auditing platforms (e.g., Episource, Veradigm, Cotiviti). Master's degree in Data Science, Health Informatics, Biostatistics, or a related field. Formal training in data governance frameworks, audit readiness methodologies, or advanced analytics (e.g., DAMA, CDMP, or equivalent). Training in Medicare Advantage regulations, CMS reporting requirements (encounter data, RADV, HEDIS, STAR ratings, interoperability), and general health plan operations. Familiarity with Python or R. Certified Risk Adjustment Coder (CRC) issued by AAPC, or Certified Professional Coder (CPC); or relevant data science/analytics certifications (e.g., CDMP, Databricks, Microsoft Azure Data Fundamentals).
Alignment Health operates within the Hospitals and Health Care industry, with its headquarters located in Orange, California. The organization focuses on transforming health care delivery by prioritizing patient well-being over traditional payment structures. Its approach involves identifying and eliminating systemic inefficiencies to align the goals of patients, providers, and payers toward improved wellness outcomes. By leveraging data-management technology and practices derived from Medicare Advantage, the company serves seniors, the chronically ill, and frail individuals who require specialized attention.
The company provides partners and patients with customized care and service tailored to specific needs, whether in clinical coordination, risk management, or technology facilitation. Alignment Health offers health plan options directly through Alignment Health Plan while also collaborating with select health plans to deliver enhanced benefits at reduced costs. This model aims to lower expenses while simultaneously improving the quality of life for those it serves. For additional details regarding its services and offerings, the organization directs inquiries to its official website at www.alignmenthealthcare.com.
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