Payer Strategy Executive: Risk, Quality & Data Exchange

Veradigm Inc.; North Carolina; Hybrid; USD 163,000 - 216,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Retirement plan

Life insurance

Paid time off

Job summary

Veradigm seeks a Veradigm Outcome Executive to lead strategic relationships with enterprise payer accounts, focusing on risk adjustment, HEDIS/Stars, and payer-provider data exchange. You will own the client relationship end to end, coordinating across Sales, Consulting, Support and A/R to drive retention and expansion.

The role requires executive engagement, annual account planning, QBR cadence, and collaboration with Legal, InfoSec and Privacy to move agreements to signature while aligning

Responsibilities

• Serve as the primary strategic partner to C-suite and senior leadership in assigned payer accounts.
• Build executive relationships through on-site visits, quarterly business reviews (QBRs), and proactive engagement.
• Understand and document each plan’s enterprise priorities — Stars and HEDIS targets, risk adjustment accuracy, medical loss ratio pressure, value-based care strategy, and interoperability mandates.
• Analyze plan membership, line-of-business mix, and product utilization data to identify whitespace across Medicare Advantage, Medicaid, commercial, and ACA lines of business; translate findings into actionable pipeline and sales strategy.
• Position Veradigm risk adjustment and quality solutions against each plan’s annual program cycle — chart retrieval and review, supplemental data submission, gap identification and closure, and audit readiness.
• Position payer-provider clinical data exchange solutions, connecting plan requirements for clinical data acquisition, interoperability compliance, and prior authorization workflow to Veradigm’s provider network and data assets.
• Drive ACV quota attainment and MBO performance through disciplined pipeline management, accurate forecasting, and timely opportunity progression.
• Navigate payer procurement, security review, and contracting processes, coordinating Legal, InfoSec, and Privacy to move enterprise agreements and data use terms to signature.
• Advocate internally for client needs — surface product feedback, coordinate cross-functional issue resolution, and represent the payer voice in roadmap and strategy discussions.
• Partner with Consulting, Support, and A/R to ensure dependable delivery and early resolution of at-risk situations before they affect retention.
• Maintain deep working knowledge of CMS and NCQA program mechanics — risk adjustment models and submission, RADV audit exposure, HEDIS measure specifications, the Medicare Advantage Stars program, and federal interoperability and prior authorization rules — to credibly advise executive stakeholders.
• Conduct whitespace and competitive analysis to expand Veradigm’s footprint within each plan and identify new use cases across additional lines of business.

Job description

Veradigm seeks a Veradigm Outcome Executive to lead strategic relationships with enterprise payer accounts, focusing on risk adjustment, HEDIS/Stars, and payer-provider data exchange. You will own the client relationship end to end, coordinating across Sales, Consulting, Support and A/R to drive retention and expansion.

The role requires executive engagement, annual account planning, QBR cadence, and collaboration with Legal, InfoSec and Privacy to move agreements to signature while aligning