Senior Business Analyst - Risk Adjustment

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

• Provide evaluation of vendor outcomes used for At-Time-of-Care Risk Adjustment solutions
• Provide data analytic and evaluation support as assigned
• Conduct data deep dives to identify unique and innovative opportunities for RAF improvement

Brief Overview

The Sr Analyst will play a key collaborative role in supporting the organization’s risk adjustment strategies and operations through advanced data analysis. This position involves analyzing all risk adjustment-related data to identify trends, gaps, and opportunities for improving risk adjustment factor (RAF) scores. The Sr Analyst will, at the direction of leadership, provide actionable insights that enhance coding accuracy, optimize revenue, and ensure compliance with CMS and HHS regulations. The ideal candidate has a strong analytical mindset, experience with healthcare data, and proficiency in data analysis and data visualization tools.

Required Qualifications

Minimum Qualifications

• 3+ years of risk adjustment working knowledge and understanding within the Medicare, Commercial ACA, and/or Medicaid line of business.  
• Management consulting, business process consulting and/or strategic business planning
• Enterprise-wide and/or cross-functional large-scale initiatives with high degree of complexity
• Demonstrated experience successfully implementing change in regulated and highly complex organizations

Preferred Qualifications

• Technical Expertise: Proficiency in SQL, Python, R, or SAS for data analysis and statistical modeling
• Data Visualization: Experience with BI tools like Tableau, Power BI, or Quick Sight to create dynamic, user-friendly reports and dashboards
• Healthcare Experience: Knowledge of healthcare risk adjustment methodologies, including HCC coding, RAF score calculation, and CMS risk adjustment guidelines
• Analytical Skills: Strong analytical mindset with experience in statistical analysis, trend identification, and performance monitoring
• Attention to Detail: High level of accuracy in reviewing data, identifying errors, and ensuring compliance with regulations
• Project Management: Ability to manage multiple projects, prioritize tasks, and deliver insights within deadlines
• Excellent knowledge of Microsoft Office products including Excel, PowerPoint, Forms, Visio, etc
• Excellent computer, proof reading, and written and verbal communication skills. Excellent interpersonal skills including the ability to communicate effectively with internal and external customer base
• Ability to lead, work independently, proactively with limited supervision, and in a collaborative manner
• Ability to work under pressure. Ability to maintain the security of confidential information
• Relevant certifications (i.e. Certified Healthcare Data Analyst CHDA)

Education

• Bachelor's degree in Business Administration/Management, Finance, Economics, Statistics, Mathematics, Data Science, HIM, Information Systems, Computer Science, or other relevant degree or 3 years of equivalent work experience in lieu of degree

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$46,988.00 - $102,000.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellnes