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Anywhere in the U.S., United States of America
Remote only
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 (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.Job Duties & 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 visualizations that enable confident decision-making.
Ensure Audit Readiness, Data Governance, and Compliance. Establish and maintain rigorous data governance standards, controls, and documentation to ensure MRA data is audit-ready, reproducible, and defensible at all times. Partner closely with Compliance to support RADV audits, internal reviews, and CMS regulatory requirements — including full traceability of submissions and supporting evidence.
Partner Strategically with Finance, Actuarial, and Clinical Stakeholders. Serve as the primary MRA data partner to Finance and Actuarial teams, providing clarity on risk adjustment program performance, revenue impacts, and variance drivers. Support Clinical Operations and JSA Outreach teams with data that enables precise member identification, chart retrieval coordination, and coding accuracy.
Direct and Develop the MRA Analytics Team. Lead, grow, and develop a multidisciplinary MRA data team spanning analytics, data science, and data engineering disciplines. Establish clear accountability structures, promote a culture of quality and continuous improvement, and ensure team outputs meet the technical and operational standards required for a highly 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 — including definitions, assumptions, and validation checks — across all MRA data outputs.
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. The Senior Director is accountable for building team capacity, setting performance standards, and developing talent to meet current and future program needs.
Supervisory Requirements: Fulfill supervisory responsibilities in accordance with organization policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
Job Requirements
Experience
Required:
7–10 years of progressive experience in healthcare data, analytics, or data operations, with direct, hands-on experience supporting Medicare Advantage Risk Adjustment programs.
Demonstrated experience leading or managing data teams responsible for regulated, audit-sensitive data environments.
Proven experience partnering with cross-functional stakeholders including clinical, finance, actuarial, and compliance teams.
Demonstrated ownership of complex, end-to-end data pipelines and analytical outputs in a healthcare or regulated industry setting.
Experience in a mid-to-large enterprise healthcare or health insurance environment, ideally a Medicare Advantage plan or managed care organization.
Must be able to work remotely, with availability from 8:00 AM to 5:00 PM Pacific Standard Time in the U.S.
Preferred:
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).
Education
Required:
Bachelor's degree in Health Informatics, Data Science, Statistics, Computer Science, Mathematics, Healthcare Administration, or a related quantitative field; or an equivalent combination of education, certification, and direct work experience.
Preferred:
Master's degree in Data Science, Health Informatics, Biostatistics, or a related field.
Training
Required:
No specific required certifications; demonstrated applied expertise in MRA data operations is essential.
Preferred:
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.
Required Skills & Competencies
Technical / Hard Skills
Medicare Risk Adjustment (MRA) Operations (Advanced) — Deep expertise in HCC coding, ICD-10 coding principles, RAF score calculation, CMS encounter data submission, and RADV audit requirements.
Data Analytics & Statistical Modeling (Advanced) — Strong analytical and modeling skills, including the ability to translate complex MRA program outcomes into quantitative metrics and executive-ready narratives.
Business Intelligence & Reporting Tools (Advanced) — Proficiency in Power BI, Tableau, or equivalent BI platforms; advanced spreadsheet modeling using Excel or Google Sheets.
SQL & Data Querying (Advanced) — Proficiency in SQL for data extraction, transformation, and analysis across large healthcare claims and encounter data sets; familiarity with Python or R is a plus.
Cloud & Data Platform Literacy (Advanced) — Familiarity with cloud data environments (Azure, AWS, GCP), data warehousing solutions, and integration with enterprise BI and analytics platforms.
Licensure
Required:
None required.
Preferred:
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).
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
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.
*DISCLAIMER: 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. Please be advised that 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 such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. 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.
