Manager, Risk Adjustment

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

📋 Description

• Supervise the risk adjustment strategies and activities at Mass Advantage.

• Implement Medicare risk adjustment initiatives to achieve business goals.

• Oversee external vendors and perform regulatory audits and compliance checks.

• Evaluate Medicare revenue initiatives for senior-focused products.

• Facilitate risk adjustment projects across various departments and provider partners.

⛳️ Requirements

• A Bachelor's degree in a relevant discipline; a Master's degree (MBA, MHA, MPH) is preferred.

• A Registered Nurse (RN) designation is desirable.

• Certification as a CRC (Certified Risk Adjustment Coder), CPC, or CCS is preferred.

• A minimum of 7 years of experience in Medicare Advantage risk adjustment, including at least 3 years in a plan-side role (not exclusively provider-side or vendor-side).

• Direct, hands-on experience with RADV, possessing working knowledge of the CMS-HCC model, including the V24-V28 transition and its financial implications.

• Proven experience managing or transitioning risk adjustment vendors (coding, chart retrieval, in-home assessment).

• Strong analytical capabilities, with the ability to analyze data directly using SQL, Power BI, or Tableau, or to accurately specify analytics requirements.

• Proficient in Microsoft Office applications (Word, Outlook, Excel, and PowerPoint).

🏝️ Benefits

• Comprehensive health benefits package.

• Opportunities for professional development and growth.

• Flexible working arrangements.

• Collaborative and inclusive work environment.