Senior Risk Adjustment Data Reconciliation Lead

Inland-Empire-Health-Plan-; Rancho Cucamonga (CA); Hybrid; USD 119,000 - 157,000; Full time

Benefits offered by this job

Competitive salary

State of the art fitness center on‑sit

Medical Insurance with Dental and Vis

Life, short-term, and long-term(dis)

Career advancement opportunities

Wellness programs

Flexible Spending Account - HealthCare

CalPERS retirement

457(b) option with a contribution test

Paid life insurance for employees

Pet care insurance

Job summary

IEHP in Rancho Cucamonga, CA is seeking a Manager of Risk Adjustment Encounter Data Reconciliation to lead end-to-end data submission and ensure accuracy for CMS/state Medicaid.

The role oversees encounter data pipelines, tracks federal response files, performs root-cause analyses, and partners with IT, claims, and QA to maintain audit readiness and maximize risk score integrity. Hybrid schedule with on-site collaboration.

Qualifications

• Minimum 5 years of progressive experience in managed care or encounter data reconciliation.
• Minimum 3 years of leadership experience managing teams or technical workflows.
• Bachelor’s degree required; Master’s preferred; professional credentials encouraged.

Responsibilities

• Oversee encounter data submission lifecycle from internal systems through CMS/state systems.
• Track and monitor federal response files (999, 277CA, MAO-002) and EDPS workflows.
• Lead root-cause analyses on rejected encounters and implement corrective action plans.
• Govern data ingestion from delegated IPAs and enforce submission SLAs.
• Manage data reconciliation dashboards ensuring audit-ready, traceable processes.
• Support RADV audits and provide data-validation trails to regulators.
• Lead and develop the Risk Adjustment team ensuring high performance.

Skills

Excel proficiency

EDI data management

Leadership

Risk adjustment

Data analysis

Communication

Education

Bachelor’s degree in business, public health, healthcare administration, informatics, or related field

Master’s degree in business, public health, healthcare administration, informatics, or related field (preferred)

CRC, CPC, CCS-P or equivalent coding credential (preferred)

Tools

EDI 837P/837I

RAPS/EDPS processing

Job description

IEHP in Rancho Cucamonga, CA is seeking a Manager of Risk Adjustment Encounter Data Reconciliation to lead end-to-end data submission and ensure accuracy for CMS/state Medicaid.

The role oversees encounter data pipelines, tracks federal response files, performs root-cause analyses, and partners with IT, claims, and QA to maintain audit readiness and maximize risk score integrity. Hybrid schedule with on-site collaboration.