Senior Risk Adjustment Manager: Medicare Strategy

Massadvantage; Worcester (MA); On-site; USD 90,000 - 120,000; Full time

Job summary

Massadvantage in Worcester, MA is seeking a Manager of Risk Management to oversee Medicare risk adjustment activities. This role involves driving strategies, ensuring compliance, and interacting with vendors and providers. Ideal candidates will have at least 7 years in risk adjustment, strong analytical skills, and proficiency in SQL and data tools like Power BI. The position emphasizes leadership in analytics and program execution while ensuring compliance with CMS regulations.

Qualifications

• Bachelor's degree in a relevant field; Master's (MBA, MHA, MPH) preferred.
• Registered Nurse (RN) desired.
• CRC (Certified Risk Adjustment Coder), CPC, or CCS certification preferred.
• 7+ years in Medicare Advantage risk adjustment, especially in a plan-side role.
• Direct RADV experience with the CMS-HCC model support.

Responsibilities

• Oversee risk adjustment activities and strategies.
• Lead RADV audit readiness and compliance.
• Build and maintain analytics layers for reporting.
• Set departmental goals and budgets aligned with strategies.

Skills

Analytical skills

Microsoft Office skills

SQL

Power BI

Tableau

Education

Bachelor's degree in a relevant field

Master's (MBA, MHA, MPH) preferred

Tools

SQL

Power BI

Tableau

Job description

Massadvantage in Worcester, MA is seeking a Manager of Risk Management to oversee Medicare risk adjustment activities. This role involves driving strategies, ensuring compliance, and interacting with vendors and providers. Ideal candidates will have at least 7 years in risk adjustment, strong analytical skills, and proficiency in SQL and data tools like Power BI. The position emphasizes leadership in analytics and program execution while ensuring compliance with CMS regulations.