Director, Risk Adjustment AI Solutions (Remote)

HealthEdge; United States; Remote; USD 170,000 - 225,000; Full time

Job summary

HealthEdge seeks a Director of Risk Adjustment Products to lead the strategy, roadmap, and execution of retrospective risk adjustment solutions. You will work with Engineering and Data Science to build real-time data pipelines and predictive models, while ensuring clinical relevance and audit readiness across payer and provider workflows.

You will mentor a high-performing team, collaborate with Sales, Clinical, and Operations, and communicate with executive stakeholders to align with CMS updates

Qualifications

• Bachelor’s degree in business or technical field required; Master’s degree preferred.
• 10+ years of Risk Adjustment product management experience required.
• 5+ years leadership experience required.
• Experience with Risk Adjustment Products, developing and executing risk adjustment strategies, managing the retrieval and interoperability roadmap, improving retrieval yield, and supporting commercial client growth.
• Experience building the product strategy from scratch, creating the roadmap and executing with the Technology and Operation stakeholders.
• Understanding of risk adjustment methodologies, including HCCs, CRGs, and other risk adjustment models used by CMS and commercial health plans.
• Understanding of Medical Record Review, digital channels and interoperability and experience in chart retrieval products or operations.
• Experience with people management, mentorship and creating inclusive and diverse teams.
• Working in AWS cloud environment and experience with AWS cloud services.
• Awareness of Agile tools and methodologies.
• Understanding of SQL, Core Java, Spring Boot, Web Services, XML, JSON, SQL, Middleware, and CI/CD pipeline philosophy.

Responsibilities

• Define multi-year plans aligned to customer outcomes, regulatory drivers, and market trends in risk adjustment, care management, and provider enablement.
• Identify and prioritize use cases that leverage AI/ML and real-time data signals to surface high-impact suspects and coding opportunities.
• Drive interoperability standards (FHIR, HL7, APIs) to enable seamless EHR integrations.
• Lead end-to-end product lifecycle from ideation to post-launch optimization.
• Build predictive models and real-time data pipelines with Engineering and Data Science.
• Ensure products are clinically relevant and integrated into payer/provider workflows.
• Set and track KPIs for risk adjustment performance and interoperability success.
• Mentor and lead a geographically dispersed team of Product Managers.

Skills

Risk adjustment product management

Leadership

Agile methodologies

Prioritization

Education

Bachelor’s degree in business or technical field

Master’s degree in business or technical field preferred

Tools

AWS Cloud Services

Core Java

Spring Boot

Web Services

XML

JSON

CI/CD pipelines

SQL

Job description

HealthEdge seeks a Director of Risk Adjustment Products to lead the strategy, roadmap, and execution of retrospective risk adjustment solutions. You will work with Engineering and Data Science to build real-time data pipelines and predictive models, while ensuring clinical relevance and audit readiness across payer and provider workflows.

You will mentor a high-performing team, collaborate with Sales, Clinical, and Operations, and communicate with executive stakeholders to align with CMS updates