Program Manager, Risk Adjustment & Stars

Alpine Physician Partners

Denver (CO)

On-site

USD 84,000 - 120,000

Full time

14 days+

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Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401(k)

Paid time off

Employee Assistance Program

Job summary

Alpine Physician Partners is seeking a Program Manager, Risk Adjustment & Stars to bridge its technical teams with operations. You will coordinate risk adjustment cycles, manage timelines, and translate CMS methodologies into actionable plans for leadership and health plan partners.

You will supervise RAF score trends, align HCC capture workflows, and ensure compliant data submission. The role requires 5–7 years in Medicare Advantage or Stars quality, a PMI credential preferred, and strong

Qualifications

Bachelor's degree in health informatics, data analytics, healthcare administration, business, or related field.
5–7 years of experience in Medicare Advantage risk adjustment and/or Star Ratings/quality improvement.
CRC credential preferred and familiarity with value-based care programs.
PMP or similar certification is a plus.

Responsibilities

Owns the annual risk adjustment and Stars improvement program cycle, coordinating between technical teams and operational/business stakeholders.
Builds and manages program timelines and throughput; reports progress to Alpine leadership and health plan partners.
Leads cross-functional workgroups spanning coding/HCC teams, clinical quality, IT, and analytics; aligns technical work with operations.
Manages program-level documentation and requirements; translates between technical specs and operational plans.
Acts as liaison between coding/data teams and operational stakeholders on HCC capture workflows and gap identification.
Monitors RAF score trends and translates findings into operational action plans.
Coordinates data submissions accuracy and reconciliation (EDS) with deadlines.
Tracks HCC model version transitions and communicates impact to leadership and business teams.
Coordinates Star Ratings strategy across measures and ensures operational execution.
Presents performance results and program recommendations to executive leadership and payer partners.

Skills

CMS HCC

RAF scoring

Cross-functional PM

Excel / SQL / BI

Education

Bachelor's degree in health informatics

Master's degree preferred

Tools

SQL

Tableau

Power BI

EDI data exchange

Job description

Are you looking to work for a company that has been recognized for over a decade as a Top Place to Work? Apply today to become a part of a company that continues to commit to putting our employees first.

Job Description

OVERVIEW OF POSITION

The Program Manager, Risk Adjustment & Stars, serves as the connective link between Alpine's technical teams (coding, data, analytics, IT) and its operational and business stakeholders (leadership, quality, health plan operations) for risk adjustment and Star Ratings performance. This role translates technical details, such as data pipelines, coding logic, and CMS methodology, into operational plans, priorities, and decisions, while ensuring operational requirements and business goals are reflected back into the technical work. The role does not require direct provider-facing engagement.

ESSENTIAL DUTIES

Program Management

Owns the annual risk adjustment and Stars improvement program cycle, coordinating between technical teams and operational/business stakeholders across prospective and retrospective programs, visit-based campaigns, and gap closure workflows.
Builds and manages program timelines and throughput; reports progress to Alpine leadership and health plan partners in clear, business-friendly terms.
Leads cross-functional workgroups spanning coding/HCC teams, clinical quality, IT, and analytics, ensuring technical work stays aligned to operational priorities.
Manages program-level documentation and requirements, translating between technical specifications and operational plans.

Risk Adjustment

Acts as the liaison between coding/data teams and operational stakeholders on HCC capture workflows, chart review pipelines, and gap identification, ensuring both sides understand priorities and constraints.
Manages relationships with vendors, coordinating technical file exchange and integration needs with operational timelines and expectations.
Monitors RAF score trends and performance results, working with analytics teams to interpret findings and translates them into operational action plans.
Coordinates risk adjustment data submission accuracy and reconciliation (EDS), connecting technical issue resolution with business and health plan deadlines.
Tracks HCC model version transitions (e.g., CMS-HCC V24/V28) and communicates their operational and financial impact to leadership and business teams.

Stars & Quality

Coordinates Alpine's Star Ratings strategy across HEDIS, CAHPS, HOS, and medication adherence measures, connecting technical measure logic with operational execution.
Partners with analytics teams to maintain measure-level performance tracking and cut-point modeling, translating results into operational priorities and gap closure plans.
Serves as one point of contact for Alpine with health plan Stars/quality teams, bridging technical data exchange requirements with operational and contractual needs.

Analytics & Reporting

Partners with analytics and data teams to define KPIs and dashboards for RAF accuracy, coding gap closure rates, and Star measure performance, ensuring outputs are operationally useful.
Translates CMS methodology updates (HCC model version changes, Star Ratings technical notes, measure weighting changes) for both technical teams (as specifications) and operational teams (as business impact).
Helps identify and elevate data integrity issues across source systems (claims, EHR, supplemental data feeds), coordinating resolution between technical and operational owners.
Presents performance results and program recommendations to Alpine executive leadership and payer partners.

Compliance & Governance

Ensures all program activities comply with CMS regulations, ICD-10-CM coding guidelines, and Alpine's compliance policies.
Supports RADV audit readiness and health plan data validation requests, coordinating between technical teams pulling data and operational/compliance teams managing the response.

EDUCATION

Bachelor's degree in health informatics, data analytics, healthcare administration, business, or related field (Master's preferred).

EXPERIENCE

Five (5) to seven (7) years of experience in Medicare Advantage risk adjustment and/or Star Ratings/quality improvement, ideally within a value-based care (VBC) setting.

Preferred Qualifications

Certified Risk Adjustment Coder (CRC) credential.
Experience with value-based care, ACOs, or delegated risk arrangements.
Familiarity with multiple health plan Stars/quality programs and data exchange requirements.
PMP or similar certification.

KNOWLEDGE, SKILLS, ABILITIES

Working knowledge of CMS HCC risk adjustment models, RAF score methodology, EDS submission processes, and Star Ratings measure specifications.
Demonstrated ability to work effectively with both technical teams (data, analytics, IT) and operational/business stakeholders, translating between the two.
Proven program/project management experience managing cross-functional initiatives involving both technical and operational workstreams.
Working proficiency in Excel required; familiarity with SQL, Tableau, Power BI, or similar tools a plus.
Strong written and verbal communication skills, with the ability to translate technical and regulatory detail for operational and executive audiences.
Skilled at translating between technical and operational audiences, comfortable in both worlds without needing to be a deep technical expert.
Strong relationship management and cross-functional collaboration skills.
Analytical and detail-oriented, able to interpret data and technical findings and turn them into operational plans.
Adaptable to evolving CMS methodology and health plan requirements.
Able to travel to meetings
Ability to handle multiple demands concurrently in a high stress environment; organize, coordinate, set priorities and meet deadlines
Home office that is HIPAA compliant for all remote or telecommuting positions as outlined by the company policies and procedures