BOI Operations Lead: Risk Adjustment & Compliance

Mosaic Health, LLC.; Raleigh, Northern (NC, KY); Hybrid; USD 81,000 - 121,000; Full time

Job summary

Mosaic Health, LLC. seeks a Manager of Burden of Illness (BOI) to oversee daily BOI operations and risk adjustment initiatives.

You will lead a team, monitor RAF accuracy and coding quality, and collaborate across Clinical Operations, Quality, and Finance to improve performance and regulatory adherence. The role requires strong leadership, CMS/HCC knowledge, and a track record in operational improvement within value-based care environments.

Qualifications

• Bachelor's degree in Healthcare Administration, Business Administration, Public Health, or related field (or equivalent experience).
• Minimum 5 years of Medicare Risk Adjustment experience.
• Minimum 2–3 years of leadership or supervisory experience.
• Experience with Medicare Advantage, MSSP ACOs, and value-based care preferred.
• Strong knowledge of CMS-HCC Risk Adjustment methodology.
• Strong leadership and team development skills.

Responsibilities

• Manage daily BOI and Risk Adjustment operations to meet departmental goals.
• Supervise, mentor, and develop BOI team members.
• Monitor KPIs, RAF accuracy, and documentation quality.
• Analyze data for workflow improvements and coding capture.
• Ensure CMS/Medicare regulatory coding and documentation compliance.
• Collaborate with Clinical Operations, Provider Relations, Quality, Finance, IT, Analytics, and Population Health.
• Oversee reporting on code validation, RAF trends, and quality metrics.
• Identify opportunities to improve technology, reporting, and efficiency.
• Develop and implement standardized workflows, policies, and best practices.
• Support provider education on documentation improvement and coding accuracy.
• Lead strategic initiatives and annual planning.

Skills

Leadership

Analytical skills

Risk Adjustment knowledge

Communication

Project management

Collaboration

Microsoft Office

Attention to detail

Education

Bachelor's degree in Healthcare Administration, Business Administration, Public Health, or related field

Tools

Microsoft Office

Reporting tools

Job description

Mosaic Health, LLC. seeks a Manager of Burden of Illness (BOI) to oversee daily BOI operations and risk adjustment initiatives.

You will lead a team, monitor RAF accuracy and coding quality, and collaborate across Clinical Operations, Quality, and Finance to improve performance and regulatory adherence. The role requires strong leadership, CMS/HCC knowledge, and a track record in operational improvement within value-based care environments.