Job Summary
CareSource is seeking a Risk Adjustment Analyst II to support our Medicare and Exchange risk adjustment programs. This role is responsible for compiling, analyzing, and reporting data to ensure completeness and accuracy of risk adjustment factors (RAF) and identifying opportunities to optimize member risk scores, ensure CMS compliance, and enhance company revenue.
Key Responsibilities
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Analyze member clinical, financial, and coding data to ensure accurate risk scores
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Review and prepare integrated reports for CMS Medicare Risk Adjustment compliance
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Identify trends and patterns to guide interventions and audit readiness
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Compare actual vs. expected MRA results to drive revenue and risk mitigation strategies
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Support revenue projection and budget development based on risk scores
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Assist in developing internal controls for CMS audit preparation (e.g., RADV)
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Perform ad hoc tasks and provide insights to senior leadership
Education & Experience
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Bachelor’s degree in accounting, finance, economics, computer science, or related field (or equivalent experience)
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2–4 years of experience in Medical Coding, Risk Adjustment, or Finance
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Experience with health risk scores, MRA analytics, and Medicare risk adjustment required
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Healthcare or Managed Care experience preferred
Skills & Competencies
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Advanced proficiency in Microsoft Excel and PowerPoint
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Working knowledge of ICD-9/10, CPT codes, and CMS Medicare Risk Adjustment
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Analytical mindset with problem-solving and critical thinking skills
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Familiarity with SQL, SAS, or similar data analytics software
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Experience with Business Intelligence (BI) tools preferred
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Excellent verbal and written communication skills
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Strong organizational and documentation skills
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AAPC or AHIMA coding certification preferred
Working Conditions
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General office environment
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May be required to sit or stand for extended periods
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Minimal travel (less than 10%)
Compensation & Benefits
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Salary range: $61,500 – $98,400, based on experience and qualifications
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Performance-based bonus eligibility
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Comprehensive total rewards package focusing on well-being and development
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Inclusive work environment and career growth opportunities
About CareSource
CareSource is a mission-driven, non-profit healthcare organization that serves millions across the U.S. We are committed to improving member health outcomes through innovation and compassionate service. Join a team that fosters inclusivity, collaboration, and professional growth.
CareSource is an Equal Opportunity Employer committed to creating a diverse and inclusive work environment. We welcome all applicants regardless of race, gender, age, disability, or background.