Medicare Risk Adjustment Data Analyst

Company Overview CSTS Customer Service and Technology Solutions LLC is a dedicated third-party administrator specializing in managing essential operational functions for insurance plans. Our focus is on streamlining processes such as claims processing, customer enrollment, premium collection, and ensuring compliance with federal regulations. We are passionate about transforming the healthcare experience by delivering outstanding products and services to our partners. Position Summary We are seeking a motivated and technically skilled Medicare Risk Adjustment Developer to support the design, development, automation, and optimization of applications, reporting solutions, and data workflows related to Medicare Advantage Risk Adjustment and Revenue Management operations. This role will primarily focus on software and data solution development while also leveraging analytical expertise to support HCC analytics, RAF reporting, coding validation, operational intelligence, and business decision-making. The ideal candidate will have hands-on experience with C#/.NET Core development, SQL, Power BI, and Python, along with the ability to collaborate with operational and analytics teams in a healthcare environment. The Developer will work closely with clinical, coding, operational, and leadership teams to enhance internal systems, automate reporting processes, improve data accuracy, and support scalable analytics solutions. Key Responsibilities Design, develop, maintain, and enhance internal applications, reporting tools, and automation solutions related to Medicare Advantage and Risk Adjustment operations. Develop and maintain .NET Core/C# applications, APIs, backend services, and data-driven workflows. Develop and maintain SQL queries, stored procedures, and database to support operational and analytical initiatives. Build and support automated reporting solutions, dashboards, and data pipelines using Power BI, SQL, Python, and related technologies. Support MRA analytics including HCCs, RAF scores, suspect conditions, recapture opportunities, and Provider and Member performance. Assist in troubleshooting application, reporting, and data integrity issues across claims, encounters, chart review, and coding datasets. Collaborate with business, coding, and operational teams to gather technical requirements and translate them into scalable solutions. Assist with the development, automation, and enhancement of internal analytics tools and workflows. Support ETL processes and integration of healthcare data from multiple internal and external systems. Perform ad hoc analysis and provide technical support for operational reporting and leadership requests. Maintain data integrity and ensure compliance with HIPAA and CMS guidelines. Required Qualifications Education Bachelor's degree in: Computer Science Software Engineering Health Information Management Data Analytics Computer Science Healthcare Administration or related field Experience 2-5+ years of experience in software development, healthcare technology, data development or analytics. Medicare Advantage, or Risk Adjustment -preferred. Experience developing applications or data solutions using C#/.NET Core and SQL required. Experience within healthcare, Medicare Advantage, Revenue Management, or Risk Adjustment environments preferred. Experience working with healthcare claims, HCC coding, RAF scores, CMS data, or operational healthcare reporting highly preferred Technical Skills Required SQL (Basic to Intermediate) Ability to write and understand queries using: SELECT statements

JOINS GROUP BY CASE

statements basic subqueries filtering and aggregation Microsoft Excel (Advanced) Pivot tables

VLOOKUP/XLOOKUP

Power Query formulas and data manipulation charts and reporting C# / .NET Core (Basic) Understanding of basic application structure Ability to read and modify simple code Familiarity with APIs or data-driven applications Python (Basic to Intermediate) Basic scripting and data analysis Familiarity with pandas or CSV/data processing preferred Power BI (Basic) Ability to build and maintain basic dashboards and reports Familiarity with data visualization concepts Basic understanding of data modeling and report filtering Ability to connect to data sources and refresh datasets Preferred Experience with: Medicare Risk Adjustment (HCC, RAF, RADV) Power BI SSMS (SQL Server Management Studio) Healthcare ETL processes Data automation and reporting tools Revenue Management or Revenue Cycle operations API integrations Azure or cloud-based environments Population health analytics SSIS or related ETL tools Knowledge & Competencies Strong software development and problem-solving skills Analytical mindset with ability to interpret healthcare and operational data Strong attention to detail and data accuracy Ability to manage multiple priorities and deadlines Strong written and verbal communication skills Ability to work independently and collaboratively within cross-functional teams Understanding of healthcare data confidentiality and HIPAA compliance Ability to bridge technical development and business operational needs. Preferred Industry Knowledge Experience or familiarity with: CMS-HCC models Medicare Advantage operations Risk Adjustment coding and recapture strategies Claims and encounter data Revenue Management Operations Provider and population health analytics Healthcare reporting and operational workflows Equal Employment Opportunity We are committed to creating an inclusive workplace where all employees are valued and respected. We are proud to be an Equal Opportunity Employer and do not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, genetic information, veteran status, or any other status protected by applicable law. We encourage candidates from all backgrounds to apply.

Pay:

From $75,000.00 per year

Work Location:

Hybrid remote in Tampa, FL 33609