Data Scientist – Generative AI & Medicare Risk Adjustment Analytics (Finance)

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

Alignment Healthcare is a data and technology driven healthcare company focused partnering with health systems, health plans and provider groups to provide care delivery that is preventive, convenient, coordinated, and that results in improved clinical outcomes for seniors.

We are seeking a mission-driven Data Scientist to join our growing team and support risk adjustment strategy within our Medicare Advantage line of business. This role focuses on enhancing risk score accuracy, CMS audit preparedness (RADV), and building AI-powered tools that improve clinical documentation review and integrity.

You'll play a key role in advancing AVA, our proprietary clinical intelligence platform, by developing next-generation models that support autonomous chart review and NLP/GenAI-driven documentation analytics. This is a unique opportunity to work at the intersection of healthcare, compliance, and machine learning-transforming how we ensure both quality and regulatory alignment.

Job Duties/Responsibilities:

Collaborate with key business leaders to understand their business problems and come up with analytical solutions. Applying coding skills and knowledge data structures to develop projects in partnership with other scientists and engineers in the team Build customer segmentation models to better understand our customers and tailor the clinical outcome and healthcare care experience for them. Build and fine-tune models for both LLMs and OCR-based document understanding, enabling accurate extraction from scanned or low-quality medical charts. Develop scalable model pipelines that integrate NLP, computer vision, and unstructured data, leveraging cloud-based infrastructure (Azure) and containerized environments. Collaborate with engineering teams to version, test, and deploy models using Git, CI/CD pipelines, and virtual machine (VM) environments. Design algorithms to predict audit risk and detect documentation anomalies across cohorts and markets. Partner with Coding, Compliance, CDI, Clinical, and Legal teams to ensure data outputs are aligned with CMS guidance. Help standardize definitions, documentation logic, and reporting workflows to scale enterprise-wide AI-readiness. Help analytical support for CMS Risk Adjustment Data Validation (RADV) audits, including:

• Audit sampling methodology validation
• Chart review error pattern identification
• Root cause analysis on deletion rates and extrapolation exposure

Supervisory Responsibilities: N/A

Minimum Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Minimum Experience:

a. 2+ years of relevant experience in predictive modeling and analysis

Education/Licensure:

a. Required: PhD in Computer Science, Engineering, Mathematics, Statistics, or related field

Other:

a. Excellent communication, analytical and collaborative problem-solving skills

b. Experience in building end to end data science solutions and applying machine learning methods to real world problems with measurable outcomes.

c. Deep understanding and experience with various machine learning algorithms, including deep neural networks, natural language processing and LLMs.

d. Solid data structures & algorithms background.

e. Strong programming skills in one of the following: Python, Java, R, Scala or C++

f. Demonstrated proficiency in SQL and relational databases.

g. Experience with data visualization and presentation, turning complex analysis into insight.

h. Experience in setting experimental analytics frameworks or strategies for complex scenarios.

i. Understanding of relevant statistical measures such as confidence intervals, significance of error measurements, development, and evaluation data sets, etc.

j. Experience with manipulating and analyzing complex, high-volume, high-dimensionality and unstructured data from varying sources

Preferred Qualifications:

i. Healthcare experience

ii. Experience in Big Data processing technologies: Hadoop, Spark, Cosmos

iii. Experience in Azure, AWS or other cloud ecosystems.

iv. Experience in NoSQL databases.

v. Published work in academic conferences or industry circles.

vi. Demonstrable track record dealing well with ambiguity, prioritizing needs, and delivering results in an agile, dynamic startup environment

vii. Knowledge of CMS Risk Adjustment Data Validation (RADV) audits

4. Work Environment:

a. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.

If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact careers@ahcusa.com.
Pay Range: $149,882.00 - $224,823.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/ . If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health's talent acquisition team, please email careers@ahcusa.com .