Manager, Burden of Illness Operations, Affiliates

Millennium Physician Group; Raleigh (NC); On-site; USD 81,000 - 121,000; Full time

Job summary

Millennium Physician Group seeks a Manager of Burden of Illness (BOI) to lead the BOI and Risk Adjustment programs. You will oversee the team, drive coding accuracy, and collaborate with Clinical Operations, Quality, Finance, IT, Analytics and Population Health to meet organizational goals.

Required: Bachelor's degree in a related field, 5+ years Medicare Risk Adjustment, 2–3 years of leadership. Strong analytical, communication, and project-management skills are essential.

Qualifications

• Bachelor's degree in a related field or equivalent work experience.
• 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 ensure timely and accurate execution of departmental goals.
• Supervise, mentor, and develop BOI team members while fostering accountability and collaboration.
• Monitor KPIs, RAF accuracy, coding trends, and documentation quality.
• Analyze operational and financial data to identify workflow improvements and increased coding capture.
• Ensure compliance with CMS, Medicare Advantage, ACO, and other regulatory requirements.
• Collaborate with Clinical Operations, Provider Relations, Quality, Finance, IT, Analytics, and Population Health to support objectives.
• Partner with vendors and health plan representatives to support performance and contractual deliverables.
• Oversee reporting related to code validation, prevalence rates, RAF trends, and quality metrics.

Skills

Leadership

Analytical thinking

Risk Adjustment knowledge

Communication

Project management

Collaboration

Attention to detail

MS Office

Education

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

Tools

MS Office

Reporting tools

Job description

Job Description SummaryJob Description SummaryThe Manager of Burden of Illness (BOI) reports to the Director of Burden of Illness. The Manager is responsible for the day-to-day management and execution of the organization's Burden of Illness and Risk Adjustment initiatives. This role oversees operational workflows, leads the BOI team, monitors performance metrics, and collaborates with internal departments and external partners to improve coding accuracy, documentation quality, and risk adjustment performance. The Manager supports organizational value-based care initiatives by ensuring operational excellence, regulatory compliance, and continuous process improvement.Essential Duties and Responsibilities• Manage daily BOI and Risk Adjustment operations to ensure timely and accurate execution of departmental goals.• Supervise, mentor, and develop BOI team members while fostering a culture of accountability, collaboration, and continuous improvement.• Monitor key performance indicators (KPIs), coding trends, provider performance, RAF accuracy, and documentation quality.• Analyze operational and financial data to identify opportunities for workflow improvements and increased coding capture.• Ensure compliance with CMS, Medicare Advantage, ACO, and other regulatory coding and documentation requirements.• Collaborate with Clinical Operations, Provider Relations, Quality, Finance, IT, Analytics, and Population Health teams to support organizational objectives.• Partner with vendors and health plan representatives to support operational performance and contractual deliverables.• Oversee reporting related to code validation, provider performance, prevalence rates, RAF trends, acceptance/rejection rates, and quality metrics.• Identify opportunities to improve technology, reporting, automation, and operational efficiency.• Develop and implement standardized workflows, policies, and best practices.• Support provider education initiatives focused on documentation improvement and coding accuracy.• Monitor coding quality through audits and provide feedback to coding staff and leadership.• Prepare and present operational reports and recommendations to department leadership.• Participate in strategic initiatives and special projects supporting value-based care and population health programs.• Assist leadership with annual operational planning, staffing, budgeting, and resource allocation.• Maintain effective communication with internal stakeholders and external partners.How will you make an impact & RequirementsThe Manager of Burden of Illness (BOI) reports to the Director of Burden of Illness. The Manager is responsible for the day-to-day management and execution of the organization's Burden of Illness and Risk Adjustment initiatives. This role oversees operational workflows, leads the BOI team, monitors performance metrics, and collaborates with internal departments and external partners to improve coding accuracy, documentation quality, and risk adjustment performance. The Manager supports organizational value-based care initiatives by ensuring operational excellence, regulatory compliance, and continuous process improvement.Essential Duties and ResponsibilitiesManage daily BOI and Risk Adjustment operations to ensure timely and accurate execution of departmental goals.Supervise, mentor, and develop BOI team members while fostering a culture of accountability, collaboration, and continuous improvement.Monitor key performance indicators (KPIs), coding trends, provider performance, RAF accuracy, and documentation quality.Analyze operational and financial data to identify opportunities for workflow improvements and increased coding capture.Ensure compliance with CMS, Medicare Advantage, ACO, and other regulatory coding and documentation requirements.Collaborate with Clinical Operations, Provider Relations, Quality, Finance, IT, Analytics, and Population Health teams to support organizational objectives.Partner with vendors and health plan representatives to support operational performance and contractual deliverables.Oversee reporting related to code validation, provider performance, prevalence rates, RAF trends, acceptance/rejection rates, and quality metrics.Identify opportunities to improve technology, reporting, automation, and operational efficiency.Develop and implement standardized workflows, policies, and best practices.Support provider education initiatives focused on documentation improvement and coding accuracy.Monitor coding quality through audits and provide feedback to coding staff and leadership.Prepare and present operational reports and recommendations to department leadership.Participate in strategic initiatives and special projects supporting value-based care and population health programs.Assist leadership with annual operational planning, staffing, budgeting, and resource allocation.Maintain effective communication with internal stakeholders and external partners.Education and ExperienceBachelor's degree in Healthcare Administration, Business Administration, Public Health, or related field or equivalent years of 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 programs preferred.Strong knowledge of CMS-HCC Risk Adjustment methodology.Required Skills and AbilitiesStrong leadership and team development skills.Excellent analytical and problem-solving abilities.Knowledge of Risk Adjustment operations and coding compliance.Strong communication and presentation skills.Ability to prioritize multiple projects in a fast-paced environment.Experience leading operational improvement initiatives.Strong collaboration and relationship-building skills.Ability to communicate complex data into actionable recommendations.High attention to detail and organizational skills.Proficiency with Microsoft Office and reporting tools.Managerial ResponsibilitiesDirectly supervise BOI team members and coding staff.Conduct hiring, onboarding, coaching, performance evaluations, and corrective action when appropriate.Establish team goals aligned with departmental objectives.Monitor productivity, quality metrics, and staff development.Promote employee engagement and professional growth.Foster collaboration across departments.Key Performance MeasuresBOI capture rate improvementRAF accuracyCoding quality scoresProvider engagement and education completionCoding turnaround timesAudit accuracyVendor performanceDepartment productivityCompliance with CMS and organizational standardsTeam engagement and retentionCompensation Range:$80,677.00to$121,015.00The anticipated base salary range represents the Company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.