Senior Risk Adjustment Leader: Strategy & Analytics

Imperial Health Plan; Pasadena (CA); On-site; USD 100,000 - 150,000; Full time

Job summary

Imperial Health Plan is seeking a Sr. Risk Adjustment Manager to lead risk adjustment operations across Medicare Advantage, Marketplace, and affiliated plans.

You will drive regulatory-compliant coding, data capture, and analytics, partnering with providers, vendors, and internal teams to optimize risk scores and forecasting. Key responsibilities include overseeing CDI initiatives, RADV readiness, and cross-functional program design, with emphasis on model updates (CMS-HCC, RxHCC) and enterprise

Qualifications

• Bachelor's degree required; equivalent combination of education and relevant experience may be considered.
• Minimum 5–7 years of progressive experience in Risk Adjustment with hands-on CMS-HCC and HHS-HCC operations.

Responsibilities

• Oversee risk adjustment programs across all lines of business, ensuring regulatory compliance and coding accuracy.
• Lead RADV audit readiness and chart review initiatives to ensure audit readiness.
• Design and maintain dashboards and reporting tools to monitor risk score trends and benchmarking.
• Collaborate with providers, ACOs, MSOs, and vendors to improve documentation and coding quality.
• Educate staff and network providers on CMS-HCC, HHS-HCC, RxHCC requirements and model changes.

Skills

CMS-HCC

HHS-HCC

RxHCC

Regulatory compliance

Analytics

Leadership

SQL

Excel

Power BI

Education

Bachelor's degree

Tools

SQL

Excel

Power BI

Tableau

Job description

Imperial Health Plan is seeking a Sr. Risk Adjustment Manager to lead risk adjustment operations across Medicare Advantage, Marketplace, and affiliated plans.

You will drive regulatory-compliant coding, data capture, and analytics, partnering with providers, vendors, and internal teams to optimize risk scores and forecasting. Key responsibilities include overseeing CDI initiatives, RADV readiness, and cross-functional program design, with emphasis on model updates (CMS-HCC, RxHCC) and enterprise