Data Scientist III - Risk Adjustment Compliance

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Data Scientist III - Risk Adjustment Compliance in United States.

This role focuses on leveraging advanced analytics and statistical modeling to ensure the quality and compliance of risk adjustment processes. You will develop models and analytical tools to identify high-risk areas, detect coding anomalies, and evaluate program effectiveness, directly influencing healthcare outcomes. Working cross-functionally, you will collaborate with technical teams, compliance, and executive stakeholders to provide actionable insights. The position emphasizes process automation, quality monitoring, and data-driven decision-making in a fast-paced, regulated environment. It is ideal for a detail-oriented professional passionate about data, compliance, and improving operational efficiency. You will also have opportunities to mentor team members and contribute to the development of scalable, high-impact analytical solutions.

Accountabilities:

The Data Scientist III will be responsible for ensuring high-quality risk adjustment data and compliance oversight:

• Develop and validate models to detect coding anomalies and identify high-risk areas.
• Create analytical tools to assess the quality of risk adjustment data and program effectiveness.
• Conduct exploratory data analysis to support regulatory compliance (CMS and OIG).
• Monitor quality metrics and recommend opportunities for improvement.
• Automate processes to scale analysis and ensure consistency across projects.
• Present findings to Risk Adjustment, Legal, Compliance, and executive teams.
• Advise Line 1 teams on systemic controls to prevent non-compliance and assist in training Data Analysts.

Candidates should have strong analytical and technical expertise:

• Bachelor’s degree in Data Science, Statistics, Information Systems, Health Informatics, or related field (or equivalent experience).
• 5+ years of experience in statistical analysis and modeling.
• 3+ years of IT experience including data warehouse, coding, or ETL processes.
• Experience with Risk Adjustment, Medicare data, ICD-10, HCC, or encounter data preferred.
• Hands-on proficiency in statistical tools such as SAS and R programming.
• Project management or project implementation experience.
• CHDA (Certified Health Data Analyst) preferred.
• Strong collaboration, communication, and problem-solving skills.

• Competitive annual salary range: $105,600 – $195,400.
• Comprehensive health, dental, and vision coverage.
• 401(k) and stock purchase plans.
• Tuition reimbursement and professional development opportunities.
• Paid time off, holidays, and flexible work schedules (remote, hybrid, or office-based).
• Total rewards may include performance-based incentives.

Jobgether is a Talent Matching Platform that partners with companies worldwide to efficiently connect top talent with the right opportunities through AI-driven job matching.

When you apply, your profile goes through our AI-powered screening process designed to identify top talent efficiently and fairly.
🔍 Our AI evaluates your CV and LinkedIn profile thoroughly, analyzing your skills, experience, and achievements.
📊 It compares your profile to the job’s core requirements and past success factors to determine your match score.
🎯 Based on this analysis, we automatically shortlist the 3 candidates with the highest match to the role.
🧠 When necessary, our human team may perform an additional manual review to ensure no strong profile is missed.

The process is transparent, skills-based, and free of bias — focusing solely on your fit for the role. Once the shortlist is completed, we share it directly with the company that owns the job opening. The final decision and next steps (such as interviews or additional assessments) are then made by their internal hiring team.

Thank you for your interest!

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