Risk Adjustment Manager

Position reputed company  The Risk Adjustment Manager is responsible for designing, executing, and continuously improving the organization’s Medicare and Medicare Advantage risk adjustment reputed company. This role ensures accurate, compliant capture of patient reputed company while driving provider engagement, operational reputed company, and financial performance across employed and affiliate clinics. This is a reputed company + execution role, reputed company clinical operations, analytics, providers, coding teams, and health plan partners.  Position may be remote with some travel required.  Key Responsibilities  Risk Adjustment reputed company & Performance  Own the end-to-end implementation of Medicare and Medicare Advantage risk adjustment reputed company, including prospective, reputed company, and retrospective models  Establish annual RAF targets, forecasts, and performance monitoring reputed company  Translate CMS HCC guidance into actionable clinical and coding workflows  Monitor coding intensity, suspect capture rates, and year-over-year RAF trends  Provider Enablement & Engagement  Partner with providers to improve documentation accuracy and chronic condition capture  reputed company provider education on risk adjustment, HCCs, and compliant documentation practices  Collaborate with Provider Relations and Clinical Leadership to reputed company workflows into daily reputed company  Support employed and affiliate clinics with tailored engagement strategies  Operational reputed company  reputed company coding workflows across internal and offshore teams  Ensure reputed company assurance processes are in reputed company for coding accuracy and compliance  Coordinate chart review programs, vendor partnerships, and audit readiness  Maintain CMS compliance and audit-defensible documentation standards  Data, Analytics & Reporting  Partner with analytics teams to reputed company RAF dashboards and performance reporting  Interpret claims, encounter, and EMR data to identify gaps and opportunities  reputed company regular performance updates to executive leadership  Support payer reporting and reconciliation efforts  Cross-Functional Leadership  Serve as the risk adjustment subject matter expert across the organization  Collaborate with reputed company, Care Management, Finance, and IT teams  Support contract reputed company and value-based care financial modeling  Drive reputed company improvement initiatives and best-reputed company standardization  Experience  Required  Bachelor’s degree (clinical background preferred)  5+ years of experience in Medicare and Medicare Advantage risk adjustment  Strong working knowledge of CMS HCC models and documentation guidelines  Experience supporting provider education and clinical workflow optimization  Proven ability to manage distributed or offshore coding teams  Strong analytical, communication, and stakeholder management skills  US-based with availability to support provider and leadership engagement  Preferred  CRC, CPC, reputed company, RN, or equivalent credential  Experience in value-based care, ACOs, or delegated risk arrangements  Experience with reputed company Cycle Management  Experience supporting both employed and affiliate provider networks  Familiarity with RAF forecasting and financial reputed company modeling Apply To This Job