Senior Manager, Risk Adjustment Market Performance

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

📋 Description

• Implement risk adjustment strategies and priorities for designated clients or markets

• Convert risk adjustment plans into detailed workplans that include milestones, responsible parties, timelines, and dependencies

• Maintain project trackers and ensure follow-up processes through to completion and measurable outcomes

• Collaborate with clinical, operational, coding, analytics, and provider-facing teams

• Recognize obstacles and opportunities, escalating issues as necessary

• Provide status reports to the Director, addressing delays, risks, and decisions needed

• Support the comprehensive risk adjustment process, including attribution, access, suspecting, gap analysis, point-of-care support, documentation, coding, retrospective review, submission, reconciliation, and audit readiness

• Leverage knowledge of Medicare Advantage, ACA/commercial, MSSP/ACO, Medicaid, and other value-based care models

• Identify ways to enhance accurate condition capture and recapture

• Track diagnoses from documentation through coding, submission, acceptance, and payer credit; address any breakdowns

• Analyze reporting to uncover performance opportunities

• Assess risk adjustment activities, trends, gaps, and outcomes

• Link performance metrics to clinical accuracy, RAF/MLR, financial implications, and operational results

• Present updates on market performance and recommendations to leadership

• Foster relationships with physicians, client leadership, coding, analytics, and provider-facing teams

• Convert coding and documentation insights into actionable guidance and educational priorities

• Drive process and behavioral changes through collaboration and recommendations

• Provide advice on workflow design, documentation practices, and process improvements

• Create reusable tools, trackers, educational resources, and processes

• Identify opportunities to implement AI-enabled tools and automation

• Ensure compliance with CMS guidelines, coding requirements, organizational standards, RADV, and other audit readiness initiatives

• Monitor performance, effectiveness of interventions, conversion of opportunities, cost per chart, and impact on providers

• Share insights and successful practices with relevant teams

⛳️ Requirements

• Bachelor’s degree in healthcare, business, health information management, or a related field; relevant experience may be accepted

• Over 5 years of experience in risk adjustment, including project leadership and direct engagement with providers, clients, or market stakeholders

• Background in a provider, payer, or health plan setting; experience in both environments is preferred

• Familiarity with CMS-HCC V28 and various lines of business, such as Medicare Advantage, ACA/commercial, MSSP/ACO, or Medicaid

• Experience with prospective, concurrent, and retrospective risk adjustment methodologies

• Proven experience collaborating with analytics, coding, clinical, operational, and provider-facing teams

• Capability to manage multiple priorities and influence change without direct authority

• Demonstrated ability to lead cross-functional projects from inception through to completion

• Active coding certification is required (CRC preferred; CPC, CCS, or equivalent accepted)

• In-depth knowledge of risk adjustment, CMS regulations, coding standards, and audit criteria

• Strong analytical, critical-thinking, and problem-solving abilities

• Skilled in translating complex data into straightforward business recommendations

• Excellent project management and organizational skills

• Strong relationship-building and provider engagement abilities

• Exceptional written, verbal, presentation, and executive communication skills

• Ability to influence and collaborate within a complex organizational structure

• Capacity to balance enterprise standards with the unique needs of clients

• Proficient in Microsoft Office and spreadsheet-based analysis

• Comfortable utilizing AI-enabled tools to enhance productivity and workflow efficiency

• Willingness to travel approximately 20% annually

🏝️ Benefits

• 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