Alignment Healthcare USA, LLC
Overview
Alignment Health is a data and technology driven healthcare company focused on providing preventive, coordinated care for seniors and those who are chronically ill. We seek a mission-driven Data Scientist to 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 to improve clinical documentation review and integrity. You will contribute to AVA, our proprietary clinical intelligence platform, developing models that support autonomous chart review and NLP/GenAI-driven documentation analytics. Responsibilities Collaborate with key business leaders to understand problems and develop analytical solutions. Apply coding skills and data structures to develop projects in partnership with other scientists and engineers. Build customer segmentation models to tailor clinical outcomes and the healthcare experience. Build and fine-tune models for both LLMs and OCR-based document understanding to extract data from scanned or low-quality charts. Develop scalable model pipelines that integrate NLP, computer vision, and unstructured data, leveraging cloud infrastructure (Azure) and containerized environments. Collaborate with engineering teams to version, test, and deploy models using Git, CI/CD, and 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 outputs align with CMS guidance. Help standardize definitions, documentation logic, and reporting workflows to scale enterprise-wide AI readiness. Provide 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
N/A Minimum Requirements
Minimum Experience:
2+ years of relevant experience in predictive modeling and analysis Education/Licensure:
Required: PhD in Computer Science, Engineering, Mathematics, Statistics, or related field Other: Excellent communication, analytical and collaborative problem-solving skills Experience in building end-to-end data science solutions and applying ML methods with measurable outcomes Deep understanding of ML algorithms, including deep neural networks, NLP, and LLMs Solid data structures & algorithms background Strong programming skills: Python, Java, R, Scala or C++ Proficiency in SQL and relational databases Experience with data visualization and presenting insights Experience in setting experimental analytics frameworks or strategies for complex scenarios Understanding of statistical measures (confidence intervals, significance, evaluation data sets) Experience with high-volume, high-dimensional and unstructured data
Preferred Qualifications:
Healthcare experience Big Data technologies: Hadoop, Spark, Cosmos Experience in Azure, AWS, or other cloud ecosystems NoSQL databases experience Published work in academic conferences or industry circles Ability to handle ambiguity, prioritize, and deliver in an agile startup environment Knowledge of CMS RADV audits
Work Environment
The work environment characteristics described here are representative of those encountered 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
While performing the duties of this job, the employee is regularly required to talk or hear; stand, walk, sit; use hands and fingers to handle or feel objects; reach with hands and arms. The employee may occasionally lift up to 10 pounds. Close vision and the ability to adjust focus are required. 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 or participating in the selection process, please contact careers@ahcusa.com. Pay Range: $149,882.00 - $224,823.00. Pay range may be based on market location, education, responsibilities, experience, etc. Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration 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. Do not provide payments or sensitive information. If you suspect a scam, report to the Federal Trade Commission at https://reportfraud.ftc.gov/#/ and verify legitimacy by contacting careers@ahcusa.com. #J-18808-Ljbffr
Alignment Health is a data and technology driven healthcare company focused on providing preventive, coordinated care for seniors and those who are chronically ill. We seek a mission-driven Data Scientist to 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 to improve clinical documentation review and integrity. You will contribute to AVA, our proprietary clinical intelligence platform, developing models that support autonomous chart review and NLP/GenAI-driven documentation analytics. Responsibilities Collaborate with key business leaders to understand problems and develop analytical solutions. Apply coding skills and data structures to develop projects in partnership with other scientists and engineers. Build customer segmentation models to tailor clinical outcomes and the healthcare experience. Build and fine-tune models for both LLMs and OCR-based document understanding to extract data from scanned or low-quality charts. Develop scalable model pipelines that integrate NLP, computer vision, and unstructured data, leveraging cloud infrastructure (Azure) and containerized environments. Collaborate with engineering teams to version, test, and deploy models using Git, CI/CD, and 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 outputs align with CMS guidance. Help standardize definitions, documentation logic, and reporting workflows to scale enterprise-wide AI readiness. Provide 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
N/A Minimum Requirements
Minimum Experience:
2+ years of relevant experience in predictive modeling and analysis Education/Licensure:
Required: PhD in Computer Science, Engineering, Mathematics, Statistics, or related field Other: Excellent communication, analytical and collaborative problem-solving skills Experience in building end-to-end data science solutions and applying ML methods with measurable outcomes Deep understanding of ML algorithms, including deep neural networks, NLP, and LLMs Solid data structures & algorithms background Strong programming skills: Python, Java, R, Scala or C++ Proficiency in SQL and relational databases Experience with data visualization and presenting insights Experience in setting experimental analytics frameworks or strategies for complex scenarios Understanding of statistical measures (confidence intervals, significance, evaluation data sets) Experience with high-volume, high-dimensional and unstructured data
Preferred Qualifications:
Healthcare experience Big Data technologies: Hadoop, Spark, Cosmos Experience in Azure, AWS, or other cloud ecosystems NoSQL databases experience Published work in academic conferences or industry circles Ability to handle ambiguity, prioritize, and deliver in an agile startup environment Knowledge of CMS RADV audits
Work Environment
The work environment characteristics described here are representative of those encountered 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
While performing the duties of this job, the employee is regularly required to talk or hear; stand, walk, sit; use hands and fingers to handle or feel objects; reach with hands and arms. The employee may occasionally lift up to 10 pounds. Close vision and the ability to adjust focus are required. 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 or participating in the selection process, please contact careers@ahcusa.com. Pay Range: $149,882.00 - $224,823.00. Pay range may be based on market location, education, responsibilities, experience, etc. Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration 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. Do not provide payments or sensitive information. If you suspect a scam, report to the Federal Trade Commission at https://reportfraud.ftc.gov/#/ and verify legitimacy by contacting careers@ahcusa.com. #J-18808-Ljbffr