Risk Adjustment - Risk Adjustment Program Manager 135-2008
On-siteTulsa, Oklahoma, United States
Job Summary
Oversee daily risk adjustment operations, including vendor management, medical record retrieval, coding quality assurance, and audit readiness for retrospective and prospective programs. Identify process gaps across retrieval, coding, and data workflows to implement improvements and establish key performance indicators for operational and financial tracking. Manage vendor SLAs, conduct audits, and coordinate corrective action plans while partnering with analytics teams to develop dashboards and ROI analysis. Lead cross-functional initiatives to resolve issues, streamline reporting accuracy, and support CMS compliance and RADV audit responses. Requires strong understanding of Medicare Advantage and ACA models with three years of healthcare analytics experience.
Required Qualifications
- Strong understanding of Medicare Advantage and ACA risk adjustment models (CMS‐HCC and HHS‐HCC) and RADV analytics
- Experience managing vendors and holding performance accountability
- Proven knowledge of CMS guidelines, RADV audits, and coding processes
- Proven ability to lead cross-functional initiatives and process improvement efforts
- Experience with reporting tools, dashboards, and data-driven decision-making
- Excellent written and verbal communication skills, including presenting to senior leadership
- Successful completion of Health Care Sanctions background check
- Bachelor's degree in analytics, statistics, health informatics, business, or related field
- Minimum of three (3) years of healthcare analytics, risk adjustment, or population health experience
- CRC, CPC, or other relevant licenses
Desired Qualifications
- Prior experience supporting production planning
- Prior experience with RAF projections
- Prior experience with prospective programs and provider engagement models
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