Director, Risk Adjustment Products

This is a fully remote position, open to applicants in United States.

📋 Description

• The Director of Risk Adjustment Products will spearhead the strategy, roadmap, and execution for the product portfolio centered around retrospective risk adjustment solutions.

• Collaborate closely with both technical and operational teams, internally and externally, to develop innovative solutions that yield measurable benefits for our customers.

• Create multi-year plans that align with customer outcomes, regulatory requirements, and market trends in risk adjustment, care management, and provider enablement.

• Identify and prioritize use cases that utilize AI/ML and real-time data signals to highlight high-impact suspects and coding opportunities.

• Foster innovation by leveraging interoperability standards (FHIR, HL7, APIs) to facilitate seamless integration with EHRs, care management platforms, and third-party systems.

• Balance innovation with compliance, audit defensibility, and clinical integrity across all product decisions.

• Oversee the complete product lifecycle, encompassing ideation, requirements gathering, development, launch, and post-launch optimization.

• Work in close partnership with Engineering and Data Science to create predictive models and real-time data pipelines that support suspecting and concurrent workflows.

• Ensure products remain clinically relevant, user-centric, and integrated into existing payer and provider workflows through interoperability integrations.

• Establish and monitor KPIs for each product line, including suspect accuracy, provider engagement, risk score impact, and rates of concurrent coding capture and correction.

• Set and monitor KPIs that evaluate both risk adjustment performance and interoperability success (data exchange rates, provider adoption).

• Act as a trusted partner and clinical product expert for internal stakeholders (Sales, Clinical, Operations, Client Success) and external clients (health plans, ACOs, risk-bearing provider groups).

• Lead customer discovery and feedback sessions to gain a comprehensive understanding of provider workflows, documentation behaviors, and concurrent coding requirements.

• Present updates on product strategy and roadmap to executive stakeholders and client advisory boards.

• Collaborate with Legal, Compliance, and Policy teams to interpret and operationalize updates from CMS (e.g., Final Rules, model updates, guidance on medical record standards).

• Implement and oversee processes that guarantee defensibility of all outputs, documentation standards, and audit trails.

• Design and integrate audit readiness into product workflows, ensuring all activities are traceable, evidence-backed, and compliant with CMS documentation requirements.

• Provide strategic recommendations and decision frameworks when weighing trade-offs between revenue, compliance, and user experience.

• Assemble, lead, and mentor a team of Product Managers working across various aspects of prospective and concurrent solutions.

• Offer mentorship, performance management, and career development opportunities aligned with leadership principles and growth culture.

• Establish best-in-class product practices and cultivate a culture of experimentation, feedback, and continuous learning.

• Aid in resourcing and hiring plans as product needs evolve and expand.

⛳️ Requirements

• A Bachelor's degree in a business or technical field is required; a Master's degree in a business or technical field is preferred.

• At least 10 years of experience in Risk Adjustment product management is required.

• A minimum of 5 years of leadership experience is required.

• Proven experience with Risk Adjustment Products, creating and implementing risk adjustment strategies, managing the retrieval and interoperability roadmap, enhancing retrieval yield, and supporting commercial client growth.

• Experience in building product strategy from the ground up, developing the roadmap, and executing with Technology and Operations stakeholders.

• A solid understanding of risk adjustment methodologies, including HCCs, CRGs, and other models utilized by CMS and commercial health plans.

• Familiarity with Medical Record Review, digital channels, and interoperability, along with experience in chart retrieval products or operations.

• Experience in people management, mentorship, and fostering inclusive and diverse teams.

• Familiarity with AWS cloud environments and experience with AWS cloud services.

• Knowledge of Agile tools and methodologies is an asset.

• Understanding of SQL, Core Java, Spring Boot, Web Services, XML, JSON, Middleware, and CI/CD pipeline philosophy.

• Ability to maintain confidentiality is essential.

• Ability to thrive in a dynamic, occasionally ambiguous environment, with a talent for quickly prioritizing needs and developing scalable processes and structures.

• Comfortable working in a fully remote environment that relies heavily on asynchronous written collaboration and communication.

🏝️ Benefits

• HealthEdge is committed to fostering an environment and culture that promotes diverse representation within our teams.

• We aspire to cultivate an inclusive workplace.

• We strive to be a place where all employees have the opportunity to belong, make a meaningful impact, and deliver exceptional software and services to our customers.