Senior Risk Adjustment Leader: Strategy & Compliance

Imperial Health Plan of California, Inc.; Pasadena (CA); On-site; USD 140,000 - 190,000; Full time

Job summary

Imperial Health Plan of California, Inc. is seeking a Sr. Manager, Risk Adjustment to lead risk adjustment operations across Medicare Advantage, Marketplace, and related programs.

You will serve as a subject matter expert on CMS/HHS risk adjustment models, ensure coding accuracy, and drive data integrity across departments. You will build reporting tools, guide RADV audit readiness, partner with providers and vendors, and align risk adjustment with enterprise forecasting and population health

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, coding, analytics, and regulatory compliance
• At least 3 years of supervisory or managerial experience leading cross-functional teams or vendor management
• Strong working knowledge of Medicare Advantage (CMS-HCC) and Marketplace (HHS-HCC) risk adjustment regulations and model methodologies
• Experience with RxHCC risk models and PDE submission processes preferred
• Familiarity with RADV audits, HHS IVA audits, and CMS data submission protocols
• Excellent verbal and written communication skills in English

Responsibilities

• Lead Risk Adjustment strategy and operations across all lines of business
• Stay current on CMS-HCC and HHS-HCC model updates and methodologies
• Manage department staff and cross-functional teams
• Build and manage risk adjustment reporting and BI dashboards
• Conduct data gap analyses and design targeted improvement strategies
• Collaborate with providers, ACOs, MSOs, and vendors to improve documentation
• Oversee vendor relationships, performance, and regulatory compliance
• Translate CMS/HHS guidance into actionable operational processes
• Support RADV audit readiness and documentation retrieval
• Integrate HCC, RxHCC, and HEDIS data across systems
• Lead provider and staff education on risk adjustment requirements
• Ensure data quality and regulatory compliance across programs
• Maintain regular operational reviews and adherence to timelines

Skills

Risk adjustment

CMS-HCC

HHS-HCC

RxHCC

Regulatory compliance

Leadership

Analytics

Education

Bachelor’s degree

Tools

SQL

Excel

Power BI

Job description

Imperial Health Plan of California, Inc. is seeking a Sr. Manager, Risk Adjustment to lead risk adjustment operations across Medicare Advantage, Marketplace, and related programs.

You will serve as a subject matter expert on CMS/HHS risk adjustment models, ensure coding accuracy, and drive data integrity across departments. You will build reporting tools, guide RADV audit readiness, partner with providers and vendors, and align risk adjustment with enterprise forecasting and population health