Director, Risk Adjustment Products

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

Overview

Overview:

The Director, Risk Adjustment Products will lead the strategy, roadmap, and execution for the product portfolio focused on retrospective risk adjustment solutions. The Director will work closely with technical and operations teams, both internally and externally, to create innovative solutions that deliver measurable impact for our customers. This is a leadership role where you will pair your product development and people management expertise to mentor a high-performance team.

The Opportunity:

• 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 innovation leveraging interoperability standards (FHIR, HL7, APIs) to enable seamless enablement with EHRs, care management platforms, and third-party integrations.
• Balance innovation with compliance, audit defensibility, and clinical integrity across all product decisions.
• Lead the end-to-end product lifecycle, including ideation, requirements gathering, development, launch, and post-launch optimization.
• Work closely with Engineering and Data Science to build predictive models and real-time data pipelines that power suspecting and concurrent workflows.
• Ensure products are clinically relevant, user-centric, and integrated into existing payer and provider workflows through interoperability integrations.
• Set and track KPIs for each product line, such as suspect accuracy, provider engagement, risk score impact, and concurrent coding capture and correction rates.
• Establish and track KPIs that measure both risk adjustment performance and interoperability success (data exchange rates, provider adoption).
• Serve as a trusted partner and clinical product expert for internal stakeholders (Sales, Clinical, Operations, Client Success) and external clients (health plans, ACOs, risk bearing provider groups).
• Lead customer discovery and feedback sessions to deeply understand provider workflows, documentation behaviors, and concurrent coding needs.
• Present product strategy and roadmap updates to executive stakeholders and client advisory boards.
• Partner with Legal, Compliance, and Policy teams to interpret and operationalize updates from CMS (e.g., Final Rules, model updates, guidance on medical record standards).
• Implement and monitor processes that ensure defensibility of all outputs, documentation standards, and audit trails.
• Design and embed audit readiness into product workflows, ensuring all activities are traceable, evidence-backed, and aligned with CMS documentation requirements.
• Provide strategic recommendations and decision frameworks when trade-offs between revenue, compliance, and user experience arise.
• Build, lead, and coach a team of Product Managers working across different facets within prospective and concurrent solutions.
• Provide mentorship, performance management, and career development aligned with leadership principles and growth culture.
• Establish best-in-class product practices and instill a culture of experimentation, feedback, and continuous learning.
• Support resourcing and hiring plans as product needs evolve and grow.
• Leads the product strategy, development and continuous refinement of the firm's risk adjustment product roadmap, ensuring it aligns with strategic goals and industry best practices
• Leads and manages teams, often geographically dispersed, responsible for risk adjustment activities, ensuring high performance and employee engagement
• Oversee the performance of automated processes, such as AI-driven chart reviews, and ensure operational excellence in risk adjustment operations
• Serve as a subject matter advisor and primary point of contact for health clients, proactively identifying and communicating risks and improvement opportunities, and ensuring client satisfaction
• Contribute to the development of long-range goals and objectives for risk adjustment programs, incorporating best practices and emerging trends
• Work with various departments, including revenue management, coding, and compliance, to align activities and promote objectives
• Build and maintain solid relationships with both internal and external stakeholders, including providers, vendors, and regulatory bodies.

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

What You Need:

• Bachelor’s degree in business or technical field required; Master’s degree in business or technical field 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.
• Ability to maintain confidentiality.
• Thrives in a dynamic, sometimes ambiguous environment and has a knack for quickly prioritizing needs and creating scalable processes and structure.
• Comfortable in a fully remote environment that relies heavily on asynchronous written collaboration and communication.

Location: Remote – USTravel required for client sessions, workshops, and internal collaboration.

HealthEdge commits to building an environment and culture that supports the diverse representation of our teams. We aspire to have an inclusive workplace. We aspire to be a place where all employees have the opportunity to belong, make an impact and deliver excellent software and services to our customers.

Geographic Responsibility: While HealthEdge is located in Boston, MA you may live anywhere in the USType of Employment: Full-time, permanentFLSA Classification (USA Only): Exempt

Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:

• The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
• Work across multiple time zones in a hybrid or remote work environment.
• Long periods of time sitting and/or standing in front of a computer using video technology.
• May require travel dependent on company needs.

The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. HealthEdge reserves the right to modify, add, or remove duties and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990. Candidates may be required to go through a pre-employment criminal background check.

HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities.

#LI-Remote

**The annual US base salary range for this positionis $170,000 to $225,000. This salary range may cover multiple career levels atHealthEdge. Final compensation will bedeterminedduring the interview process and is based on a combination of factors including, but not limited to,your skills, experience,qualificationsand education.