Principal Risk Adjustment & Revenue Integrity Analytics Lead

Your Future is our Future At Lumeris, we believe that our greatest achievements are made possible by the talent and commitment of our team members. That's why we are actively seeking talented and collaborative individuals who are passionate about making a difference in the healthcare industry. Join us today as we strive to create a system of care that every doctor wants for their own family and become part of a community that values its people and empowers you to make an impact.

We're excited to consider every qualified candidate authorized to work in the United States, although we are unable to sponsor visas for this role at this time.

Principal Risk Adjustment & Revenue Integrity Analytics Lead

The Principal Risk Adjustment & Revenue Integrity Analytics Lead is a senior, hands-on analytics leader responsible for designing, building, validating, and operationalizing Medicare Advantage Part C risk adjustment analytics. Reporting directly to the Senior Director of Health Plan Analytics, this role directly supports the Medicare Advantage plans of Essence Healthcare, serving as the analytic truth owner for Risk Adjustment by connecting risk-score performance, diagnosis and HCC capture, encounter submissions, and revenue impact into a single, trusted operating model.

The lead will partner closely with the VP of Risk Adjustment Solutions and Strategy to align technical analytic models with overall business operations and strategic interventions. The lead is expected to work independently, translating complex data from claims, encounters, eligibility, and CMS sources into actionable performance intelligence. This individual will act as a senior builder and strategic partner to Risk Adjustment, Finance, Actuarial, and other key departments.

The ideal candidate will be a domain owner who can distinguish the drivers of financial performance—whether it's population mix, model changes, or operational execution—and establish an auditable fact base for action. This role is pivotal in shifting the function from retrospective reporting to proactive risk and revenue intelligence.

• Build and Own Risk Adjustment Analytic Truth:
  Design, build, and maintain the primary analytic assets, dashboards, and reporting for Part C and Part D risk-score performance.
• Forecast Part C RAF, Bid/Budget Performance, and Revenue:
  Develop and maintain risk-score and revenue forecasting models, comparing projections to actuals and decomposing any variances into documented drivers.
• Reconcile the Diagnosis-to-Payment Lifecycle:
  Trace diagnoses and HCCs from source to payment, analyzing submission and response data (e.g., EDPS, MAO-004) to create repeatable reconciliation controls.
• Identify, Size, and Track Recovery Opportunities:
  Analyze and track opportunities such as recapture and chart reviews using documented valuation rules, ensuring clear ROI visibility and preventing double counting.
• Drive Risk Adjustment Provider, Vendor, and Operational Performance:
  Partner with internal teams to prioritize high-impact opportunities and measure performance by provider, program, vendor, and intervention.
• Automate and Scale Risk Adjustment Intelligence:
  Automate recurring reporting to reduce manual effort through scalable dashboards, reusable SQL, documented business logic, and repeatable processes.
• Own Risk Adjustment Business Logic and Data Trustworthiness:
  Own the domain's business logic, metric definitions, and data quality criteria to ensure all reporting is accurate, reproducible, and fit for executive use.
• Communicate Executive-Ready Performance Narratives:
  Translate complex model, coding, and financial logic into clear, decision-ready narratives for leadership and non-technical…