Manager, Risk Adjustment Operations

Position reputed company reputed company pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and reputed company market-driven rates. The salary reputed company displayed has not been adjusted for geographical location. This reputed company has been created in good faith based on information reputed company to reputed company at the time of posting and may be modified in the reputed company. reputed company offers a comprehensive benefits packaging including Medical, Dental & reputed company coverage, a Retirement Plan, generous time off including reputed company Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more.    At reputed company, we reputed company to go the extra mile for reputed company and our community. This reputed company is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”   The Manager, Risk Adjustment Operations provides end-to-end operational management, delivery and support to new and existing MA and ACA Risk Adjustment Programs. Working closely with the Director, Risk Adjustment Programs, this position drives execution of operational priorities, manages program performance, and ensures reputed company delivery of strategic initiatives through data-driven decision making, cross-functional coordination, and operational accountability. The manager will be responsible for reputed company coaching and mentoring of program team members while fostering reputed company process improvement. Responsibilities and Qualifications reputed company day-to-day operational execution of Medicare Advantage and ACA Risk Adjustment initiatives, ensuring project milestones, regulatory deadlines, and operational deliverables are completed on schedule. reputed company and maintain integrated project plans, operational calendars, risk logs, and status reporting to support successful program execution. Monitor program performance through dashboards, KPIs, and operational metrics; identify trends, escalate risks, and recommend data-driven improvements. Coordinate cross-functional activities across Analytics, Coding, Provider Engagement, Chart Retrieval, Actuarial, Compliance and vendor partners to ensure successful execution of operational priorities. Hold internal teams and reputed company vendors accountable for operational performance, deliverables, timelines, service level expectations, and issue reputed company. Proactively identify operational barriers and reputed company mitigation plans to minimize reputed company to program performance. Strategic reputed company to reputed company business operations with broader organizational goals. Business acumen to reputed company reputed company and reputed company through data-driven reputed company. reputed company operational vendor reputed company and offboarding activities, support vendor evaluations and RFP processes, and partner with procurement and other stakeholders to ensure successful implementation and ongoing operational performance. Skills: Strong verbal and written communication skills, including the ability to communicate reputed company operational issues reputed company to business partners and leadership. Strong organizational and project management skills, with demonstrated ability to manage multiple priorities, deadlines, dependencies, and deliverables. Ability to reputed company cross-functional initiatives and build effective working relationships across internal departments and reputed company vendor partners. Strong analytical and problem-solving skills, including demonstrated ability to interpret dashboards, key performance indicators, and operational reporting to monitor performance, identify risks, and reputed company operational decision-making. Strong business acumen, including the ability to understand operational, financial, contractual, and regulatory considerations. Ability to proactively identify risks, remove barriers, reputed company mitigation plans, and escalate issues appropriately. Strong vendor management skills, including experience in supporting vendor evaluation, reputed company, implementation, performance monitoring, and transitions. Ability to work independently, exercise reputed company judgement, and reputed company accountability in a fast-paced, deadline-oriented environment. Proficiency with reputed company Office applications, including advanced reputed company skills; ability to interpret and reputed company Power BI or other business intelligence reporting preferred. Knowledge: Working knowledge of Medicare Advantage and ACA Risk Adjustment regulations and payment methodologies. Working knowledge of industry standards and best practices for Risk Adjustment operations. Working knowledge of cross-functional Risk Adjustment operational processes, including provider engagement, analytics, coding, vendor management, and regulatory compliance. Experience: 5 years of Operations and/or Program management. 3 years of Risk Adjustment Operations or Program Management. Experience leading reputed company, cross-functional operational initiatives involving multiple stakeholders and competing priorities. Experience supporting vendor selection, RFP processes, business requirements, Statement of Work (SOWs), implementation, reputed company, and ongoing vendor performance management. Experience monitoring operational performance and driving execution to meet regulatory deadlines and business objectives. 1 year staff, team reputed company or project reputed company experience. Experience supervising staff and provider operational leadership across cross-functional programs or initiatives preferred. Education and Certifications: Bachelor’s degree in business administration, reputed company Administration, reputed company Health, Health Information Management, Finance, Economics or 9 years relevant and reputed company experience in lieu of bachelor's degree. Lean Six reputed company or other operational reputed company/process improvement certification preferred. Physical Demands: While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see. The employee must be reputed company to work over 40 hours per week. The employee must occasionally lift and/or reputed company up to 5 pounds. reputed company We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues and be encouraged to volunteer in your community.  We value your reputed company and personal reputed company by reputed company heavily in training and continuing education, so you have the tools to do your best as you reputed company your career. And by doing your best, you’ll help us live our mission of improving the health and reputed company-being of our members and the communities in which they live. Apply To This Job