Strategic Risk Adjustment Lead — Analytics & Compliance

Evolving Solution Services; United States; On-site; USD 100,000 - 150,000; Full time

Job summary

Evolving Solution Services is seeking a Sr. Risk Adjustment Manager to lead and optimize risk adjustment operations across Medicare Advantage, Marketplace, and affiliated plans. You will collaborate with internal teams, providers, and partners to improve risk capture, regulatory compliance, and data integrity.

You will develop and operationalize reporting tools, manage cross-functional teams, and drive RADV audit readiness while aligning with financial forecasting and population health goals.

Qualifications

• Bachelor’s degree or equivalent in a relevant field.
• 5–7 years of risk adjustment experience with CMS-HCC and HHS-HCC.
• Experience supervising or managing cross-functional teams.
• Strong knowledge of Medicare Advantage and Marketplace risk adjustment regulations.
• Experience with data analytics, SQL, and reporting.

Responsibilities

• Lead Risk Adjustment Strategy & Operations across all lines of business.
• Ensure regulatory compliance and coding accuracy.
• Develop dashboards and BI tools to monitor risk score trends and audit readiness.
• Lead RADV audit readiness and vendor management.
• Educate providers and staff on CMS/HHS RxHCC requirements.

Skills

CMS-HCC

HHS-HCC

RxHCC

Coding accuracy

SQL

Excel

Leadership

Vendor management

Regulatory compliance

Data analytics

Education

Bachelor’s degree or equivalent

Tools

SQL

Power BI

Tableau

Job description

Evolving Solution Services is seeking a Sr. Risk Adjustment Manager to lead and optimize risk adjustment operations across Medicare Advantage, Marketplace, and affiliated plans. You will collaborate with internal teams, providers, and partners to improve risk capture, regulatory compliance, and data integrity.

You will develop and operationalize reporting tools, manage cross-functional teams, and drive RADV audit readiness while aligning with financial forecasting and population health goals.