Manager, CMS Merit Incentive Program

PRISM Vision Group; New Providence (NJ); Hybrid; USD 90,000 - 125,000; Full time

Job summary

PRISM Vision Group in New Providence, NJ is seeking a Manager of the CMS Merit Incentive Program to lead provider enablement for Medicare Advantage and Individual business lines, driving MIPS reporting and performance improvements. This hybrid role requires strategic engagement with providers, operations leadership, IT, and clinical teams to ensure compliant, scalable reporting.

The incumbent will oversee quality improvement programs, training, and cross-functional initiatives while coordinating

Qualifications

• BA/BS degree in Business, Health Care Administration and/or social sciences or clinically related.
• 10 years of experience working with physicians or health plans or equivalent combination of education and experience.

Responsibilities

• Serve as the centralized lead for all MIPS quality reporting activities across the organization.
• Oversee ongoing MIPS workflow review, compliance monitoring, reporting validation, and due diligence related to measuring performance and documentation integrity.
• Conduct routine audits of provider and staff workflows to identify gaps impacting MIPS capture, reporting accuracy, and outcomes.
• Monitor and analyze MIPS performance trends, identify at-risk measures, and coordinate remediation plans with operations leadership, providers, IT, and clinical teams. Review and validate MIPS reporting outputs, documentation workflows, utilization, and measure logic to ensure reporting accuracy and consistency across divisions.
• Manage and coordinate all MIPS-related training initiatives for providers, office managers, campus trainers, clinical staff, virtual scribes, and operational leadership.
• Facilitate structured MIPS education sessions covering:
• Measure documentation workflows in Nextech
• Reporting and dashboard review
• Workflow remediation and optimization
• Regulatory updates and reporting requirements
• Act as the primary liaison between operations, Anatomy IT, Nextech, Verana/IRIS Registry, compliance teams, and organizational leadership for all MIPS-related initiatives and issue resolution.
• Participate in recurring executive, divisional, and vendor meetings regarding MIPS reporting, system functionality, regulatory updates, ticket management, and workflow optimization.
• Lead projects, retrospective chart reviews, documentation remediation efforts, and year-end performance optimization initiatives.
• Support integrations, acquisitions, EHR transitions, and operational rollouts to ensure continuity of MIPS reporting workflows and regulatory compliance.
• Develop and maintain standardized MIPS workflows, documentation guides, quick-reference materials, and operational policies.
• Monitor CMS specification changes, registry updates, and vendor communications to proactively adjust workflows and reporting strategies as needed.
• Ensure organizational readiness for MIPS submission periods, audits, reporting deadlines, and compliance reviews.
• Serve as an internal subject matter expert for MIPS-related operational, regulatory, and workflow questions across all divisions.
• Maintain strong cross-functional collaboration with operations, compliance, IT, revenue cycle, providers, virtual scribe teams, and external vendors to support ongoing reporting success and scalability.

Job description

Overview

This exempt role can is a HYBRID role with travel to New Providece, NJ.

Compensation Range: $90,000 to $125,000/Annually (Commensurate with experience, qualifications, and demonstrated CMS Merit Incentive Program and healthcare experience.)

The Manager of the CMS Merit Incentive Program leads provider enablement for Medicare Advantage and Individual business lines, focusing on improving clinical and financial outcomes through value-based arrangements. This role requires expertise in Medicare Advantage, CMS Stars Program, and strong business acumen to drive competitive performance and manage teams effectively.

Lead provider enablement and performance: Responsible for implementing provider enablement strategies to enhance Medicare Advantage Star Ratings and risk adjustment results by engaging providers and improving clinical and financial performance.

Strategic and operational expertise: Requires strategic provider engagement skills, operational oversight of incentive payment processes, and leadership experience within healthcare or payer health plan environments.

Program management and collaboration: Oversees Medicare Quality Improvement Programs, collaborates on value-based arrangements, drives provider engagement in clinical programs, and ensures compliance with CMS expectations while managing cross-functional teams to deliver results.

This position reports to the VP, Payer and Strategy Relations.

Responsibilities

Key Responsibilities:

• Serve as the centralized lead for all MIPS quality reporting activities across the organization.
• Oversee ongoing MIPS workflow review, compliance monitoring, reporting validation, and due diligence related to measuring performance and documentation integrity.
• Conduct routine audits of provider and staff workflows to identify gaps impacting MIPS capture, reporting accuracy, and outcomes.
• Monitor and analyze MIPS performance trends, identify at-risk measures, and coordinate remediation plans with operations leadership, providers, IT, and clinical teams. Review and validate MIPS reporting outputs, documentation workflows, utilization, and measure logic to ensure reporting accuracy and consistency across divisions.
• Manage and coordinate all MIPS-related training initiatives for providers, office managers, campus trainers, clinical staff, virtual scribes, and operational leadership.
• Facilitate structured MIPS education sessions covering:
• Measure documentation workflows in Nextech
• Reporting and dashboard review
• Workflow remediation and optimization
• Regulatory updates and reporting requirements
• Act as the primary liaison between operations, Anatomy IT, Nextech, Verana/IRIS Registry, compliance teams, and organizational leadership for all MIPS-related initiatives and issue resolution.
• Participate in recurring executive, divisional, and vendor meetings regarding MIPS reporting, system functionality, regulatory updates, ticket management, and workflow optimization.
• Lead projects, retrospective chart reviews, documentation remediation efforts, and year-end performance optimization initiatives.
• Support integrations, acquisitions, EHR transitions, and operational rollouts to ensure continuity of MIPS reporting workflows and regulatory compliance.
• Develop and maintain standardized MIPS workflows, documentation guides, quick-reference materials, and operational policies.
• Monitor CMS specification changes, registry updates, and vendor communications to proactively adjust workflows and reporting strategies as needed.
• Ensure organizational readiness for MIPS submission periods, audits, reporting deadlines, and compliance reviews.
• Serve as an internal subject matter expert for MIPS-related operational, regulatory, and workflow questions across all divisions.
• Maintain strong cross-functional collaboration with operations, compliance, IT, revenue cycle, providers, virtual scribe teams, and external vendors to support ongoing reporting success and scalability.

Qualifications

Qualifications

• BA/BS degree in Business, Health Care Administration and/or social sciences or clinically related.
• 10 years of experience working with physicians or health plans or equivalent combination of education and experience.