Senior Manager, Risk Stratification Operations, Remote

Aledade, Inc.; Bethesda (MD); Remote; USD 90,000 - 120,000; Full time

Job summary

A leading company in healthcare is seeking a Senior Manager of Risk Adjustment to lead programs ensuring accurate diagnosis documentation. This role involves collaboration across teams, managing payer relationships, and developing strategies to enhance risk adjustment accuracy. The ideal candidate will have extensive experience in healthcare, particularly in risk adjustment and program management.

Qualifications

• 5+ years of experience with payer, health plan, or value-based care companies.
• 5+ years of risk adjustment experience, including Medicare and MSSP.
• Management experience of 5+ years.

Responsibilities

• Lead and coach process owners to optimize coding and documentation.
• Manage risk payer relationships and track diagnosis submissions.
• Develop strategies to improve risk adjustment accuracy.

Skills

Leadership

Collaboration

Analytical Interpretation

Education

Bachelor’s degree in Healthcare Administration

MBA

MHA

Tools

Microsoft Office

Google Suite

SQL

PowerBI

SAS

Job description

The Senior Manager of Risk Adjustment is responsible for leading programs and processes to ensure complete and accurate diagnosis documentation and risk adjustment. This role involves collaboration across teams to achieve organizational goals.

Primary Duties :

1. Lead and coach process owners and improvement teams to optimize accurate coding, billing, and documentation. Act as a liaison for multiple teams in a matrixed environment, collaborating with clinical, market, compliance, and legal teams.
2. Manage risk payer relationships. Lead the team responsible for tracking diagnosis submissions throughout the risk process and overall workflow.
3. Engage with payers to promote risk programs.
4. Own reporting for meetings with payer leaders related to risk adjustment.
5. Oversee development of reports covering all stages of the risk adjustment process.
6. Collaborate with BI and Impact Analytics to assess the impact of various interventions.
7. Serve as a key business stakeholder and subject matter expert in risk adjustment for the BI and Analytics team.
8. Coordinate with analytics teams to discuss risk trends, understand patterns, and assist with analytical interpretation.
9. Support operational execution in collaboration with the performance team.
10. Develop strategies and tactics to improve risk adjustment accuracy through technology, product, and program enhancements.
11. Work with stakeholders on projects and programs.

Minimum Qualifications :

1. Bachelor’s degree in Healthcare Administration, Business, or equivalent training.
2. 5+ years of experience with payer, health plan, or value-based care companies, including Medicare and Commercial.
3. 5+ years of risk adjustment experience, including Medicare and MSSP.
4. Knowledge of risk adjustment methodologies such as HCC, 3M, Milliman, etc.
5. 5+ years of program management, project leadership, and execution experience in healthcare or related fields.
6. Management experience of 5+ years.
7. Proficiency in Microsoft Office, Project/Product Management tools, and Google Suite.

Preferred :

1. MBA, MHA, or other Master’s level training in health, business, or IT.
2. Additional 5+ years in program management and project leadership within healthcare or related fields.
3. Proven leadership in managing teams and high-impact portfolios, with internal and external representation responsibilities.
4. Advanced skills in Microsoft Office, Project/Product Management, and Analytics tools such as SQL, PowerBI, SAS.