Senior Manager, Risk Adjustment Market Performance

• Deliver risk adjustment initiatives and priorities for assigned clients or markets
• Translate risk adjustment plans into structured workplans with milestones, owners, timelines, and dependencies
• Maintain project trackers and follow-up cadence through completion and measurable results
• Coordinate with clinical, operational, coding, analytics, and provider-facing teams
• Identify barriers and opportunities and escalate issues appropriately
• Provide status updates to the Director, including delays, risks, and required decisions
• Support the end-to-end risk adjustment continuum, including attribution, access, suspecting, gap analysis, point-of-care support, documentation, coding, retrospective review, submission, reconciliation, and audit readiness
• Apply knowledge of Medicare Advantage, ACA/commercial, MSSP/ACO, Medicaid, and other value-based care models
• Identify opportunities to improve accurate condition capture and recapture
• Trace diagnoses from documentation through coding, submission, acceptance, and payer credit; resolve breakdowns
• Interpret reporting and identify performance opportunities
• Evaluate risk adjustment activity, trends, gaps, and outcomes
• Connect performance to clinical accuracy, RAF/MLR, financial impact, and operational results
• Present market performance updates and recommendations to leadership
• Build relationships with physicians, client leadership, coding, analytics, and provider-facing teams
• Translate coding and documentation findings into practical guidance and education priorities
• Influence process and behavior changes through collaboration and recommendations
• Advise on workflow design, documentation practices, and process changes
• Develop reusable tools, trackers, educational materials, and processes
• Identify opportunities to use AI-enabled tools and automation
• Support compliance with CMS guidance, coding requirements, organizational standards, RADV, and other audit readiness activities
• Monitor performance, intervention effectiveness, opportunity conversion, cost per chart, and provider burden
• Share lessons learned and successful practices with relevant teams

• Bachelor's degree in healthcare, business, health information management, or related field; equivalent experience may be considered
• 5+ years of risk adjustment experience, including project leadership and direct interaction with providers, clients, or market stakeholders
• Experience in a provider, payer, or health plan environment; experience in both is preferred
• Experience with CMS-HCC V28 and multiple lines of business, such as Medicare Advantage, ACA/commercial, MSSP/ACO, or Medicaid
• Experience with prospective, concurrent, and retrospective risk adjustment
• Experience partnering with analytics, coding, clinical, operational, and provider-facing teams
• Experience leading multiple priorities and influencing change without direct authority
• Demonstrated experience managing cross-functional projects from planning through completion
• Active coding certification required (CRC preferred; CPC, CCS, or equivalent accepted)
• Strong knowledge of risk adjustment, CMS requirements, coding guidelines, and audit standards
• Strong analytical, critical-thinking, and problem-solving skills
• Ability to translate complex data into clear business recommendations
• Strong project management and organizational skills
• Strong provider engagement and relationship-building skills
• Excellent written, verbal, presentation, and executive communication skills
• Ability to influence and collaborate across a complex organization
• Ability to balance enterprise standards with client-specific needs
• Proficiency with Microsoft Office and spreadsheet-based analysis
• Comfortable using AI-enabled tools to improve productivity and workflow efficiency
• Ability to travel approximately 20% annually

• Medical, Dental, Vision, Life, Long/Short Term Disability
• Health Savings Account/Flexible Spending Account
• Fraud Protection
• Legal, Pet and other fringe benefits
• Generous PTO policy
• 9 paid holidays
• 401k match
• Profit sharing
• Tuition reimbursement
• Wellness program
• Opportunities for professional growth and mentorship
• Emphasis on work-life balance