Burden of Illness Operations & Risk Adjustment Manager

Millennium Healthcare Management Serv LLC; Raleigh (NC); On-site; USD 81,000 - 121,000; Full time

Job summary

Mosaic Health is seeking a Manager of Burden of Illness (BOI) to lead day-to-day BOI and Risk Adjustment operations, supervise the BOI team, and drive accuracy in coding and documentation. You will collaborate with Clinical Operations, Finance, IT, and external partners to improve RAF accuracy, monitor KPIs, and ensure CMS compliance while supporting risk-adjusted value-based care initiatives.

Minimum five years in Medicare Risk Adjustment with leadership experience; Bachelor's degree required.

Qualifications

• Bachelor's degree in Healthcare Administration, Business Administration, Public Health or related field.
• Minimum 5 years of Medicare Risk Adjustment experience.
• Minimum 2-3 years of leadership or supervisory experience.

Responsibilities

• Manage daily BOI and Risk Adjustment operations to meet departmental goals.
• Supervise BOI team members and foster accountability and continuous improvement.
• Monitor KPIs, RAF accuracy, coding trends, and documentation quality.
• Collaborate with Clinical Operations, Provider Relations, Finance, IT, Analytics, and Population Health.
• Prepare and present operational reports and recommendations to leadership.

Skills

Leadership

Analytical ability

Risk Adjustment knowledge

Communication

Project prioritization

Operational improvement

Collaboration

Data storytelling

Attention to detail

MS Office / Reporting tools

Education

Bachelor's degree in Healthcare Administration or related field

Tools

Microsoft Office

Reporting tools

Job description

Mosaic Health is seeking a Manager of Burden of Illness (BOI) to lead day-to-day BOI and Risk Adjustment operations, supervise the BOI team, and drive accuracy in coding and documentation. You will collaborate with Clinical Operations, Finance, IT, and external partners to improve RAF accuracy, monitor KPIs, and ensure CMS compliance while supporting risk-adjusted value-based care initiatives.

Minimum five years in Medicare Risk Adjustment with leadership experience; Bachelor's degree required.