Risk Adjustment Program Manager

Mass General Brigham; Somerville (MA); Remote; USD 80,000 - 110,000; Full time

Job summary

An established industry player in healthcare is seeking a dedicated professional to lead risk adjustment projects that enhance patient care and ensure compliance with regulations. This role offers the chance to work in a supportive and diverse environment, emphasizing equity and inclusion. You will manage vendor relationships, present complex analytics to executive leadership, and contribute to innovative health solutions. With flexible work options, including remote opportunities, this position is ideal for those looking to advance their careers within a leading integrated healthcare system.

Benefits

Competitive Salary

Flexible Work Options

Career Growth Opportunities

Diverse Work Environment

Qualifications

• 3-5 years of experience in risk adjustment and project leadership.
• Knowledge of healthcare regulations and compliance.

Responsibilities

• Lead risk adjustment projects from conception to implementation.
• Manage vendor relationships and ensure compliance with regulations.

Skills

Risk Adjustment

Project Management

Data Analysis

Vendor Management

Education

Bachelor's Degree

Master's Degree

Tools

CMS Risk Adjustment

HHS Commercial Risk Adjustment

Job description

Employer Industry: Healthcare

Why consider this job opportunity:
- Competitive salary with flexible work options
- Opportunity for career growth and advancement within a leading integrated healthcare system
- Remote work opportunity available from most U.S. states
- Chance to contribute to innovative health solutions and improve patient care
- Supportive and diverse work environment emphasizing equity and inclusion

What to Expect (Job Responsibilities):
- Lead internal and external risk adjustment projects from conception to implementation
- Manage vendor relationships and negotiate contracts as necessary
- Develop and present complex analytics to communicate financial performance
- Communicate directly with executive leadership regarding risk adjustment analytics
- Ensure compliance with CMS and MassHealth regulations and participate in audits

What is Required (Qualifications):
- Bachelor’s degree required; Master’s degree preferred
- 3-5 years of experience in risk adjustment
- Previous experience leading complex projects and presenting to executive levels required
- Knowledge of CMS Risk Adjustment, HHS Commercial Risk Adjustment, and MassHealth risk adjustment practices
- Medical coding certification or equivalent experience preferred

How to Stand Out (Preferred Qualifications):
- 1-2 years of leadership experience preferred
- Previous experience with CMS risk adjustment audits (RADV) preferred
- Deep understanding of healthcare regulations related to risk adjustment
- Ability to analyze data for risk adjustment score improvement
- Experience collaborating with healthcare professionals to enhance clinical documentation

#Healthcare #RiskAdjustment #ProjectManagement #RemoteWork #DiversityAndInclusion

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