Risk Adjustment Manager
Position Summary
The Risk Adjustment Manager is responsible for designing, executing, and continuously improving the organization’s Medicare and Medicare Advantage risk adjustment strategy. This role ensures accurate, compliant capture of patient acuity while driving provider engagement, operational excellence, and financial performance across employed and affiliate clinics. This is a strategy + execution role, bridging clinical operations, analytics, providers, coding teams, and health plan partners.
Position may be remote with some travel required.
Key Responsibilities
Risk Adjustment Strategy & Performance
Own the end-to-end implementation of Medicare and Medicare Advantage risk adjustment strategy, including prospective, concurrent, and retrospective models
Establish annual RAF targets, forecasts, and performance monitoring cadence
Translate CMS HCC guidance into actionable clinical and coding workflows
Monitor coding intensity, suspect capture rates, and year-over-year RAF trends
Provider Enablement & Engagement
Partner with providers to improve documentation accuracy and chronic condition capture
Lead provider education on risk adjustment, HCCs, and compliant documentation practices
Collaborate with Provider Relations and Clinical Leadership to embed workflows into daily practice
Support employed and affiliate clinics with tailored engagement strategies
Operational Oversight
Oversee coding workflows across internal and offshore teams
Ensure quality assurance processes are in place for coding accuracy and compliance
Coordinate chart review programs, vendor partnerships, and audit readiness
Maintain CMS compliance and audit-defensible documentation standards
Data, Analytics & Reporting
Partner with analytics teams to develop RAF dashboards and performance reporting
Interpret claims, encounter, and EMR data to identify gaps and opportunities
Provide regular performance updates to executive leadership
Support payer reporting and reconciliation efforts
Cross-Functional Leadership
Serve as the risk adjustment subject matter expert across the organization
Collaborate with Quality, Care Management, Finance, and IT teams
Support contract strategy and value-based care financial modeling
Drive continuous improvement initiatives and best-practice standardization
Experience
Required
Bachelor’s degree (clinical background preferred)
5+ years of experience in Medicare and Medicare Advantage risk adjustment
Strong working knowledge of CMS HCC models and documentation guidelines
Experience supporting provider education and clinical workflow optimization
Proven ability to manage distributed or offshore coding teams
Strong analytical, communication, and stakeholder management skills
US-based with availability to support provider and leadership engagement
Preferred
CRC, CPC, CCS, RN, or equivalent credential
Experience in value-based care, ACOs, or delegated risk arrangements
Experience with Revenue Cycle Management
Experience supporting both employed and affiliate provider networks
Familiarity with RAF forecasting and financial impact modeling
Apply To This Job
The Risk Adjustment Manager is responsible for designing, executing, and continuously improving the organization’s Medicare and Medicare Advantage risk adjustment strategy. This role ensures accurate, compliant capture of patient acuity while driving provider engagement, operational excellence, and financial performance across employed and affiliate clinics. This is a strategy + execution role, bridging clinical operations, analytics, providers, coding teams, and health plan partners.
Position may be remote with some travel required.
Key Responsibilities
Risk Adjustment Strategy & Performance
Own the end-to-end implementation of Medicare and Medicare Advantage risk adjustment strategy, including prospective, concurrent, and retrospective models
Establish annual RAF targets, forecasts, and performance monitoring cadence
Translate CMS HCC guidance into actionable clinical and coding workflows
Monitor coding intensity, suspect capture rates, and year-over-year RAF trends
Provider Enablement & Engagement
Partner with providers to improve documentation accuracy and chronic condition capture
Lead provider education on risk adjustment, HCCs, and compliant documentation practices
Collaborate with Provider Relations and Clinical Leadership to embed workflows into daily practice
Support employed and affiliate clinics with tailored engagement strategies
Operational Oversight
Oversee coding workflows across internal and offshore teams
Ensure quality assurance processes are in place for coding accuracy and compliance
Coordinate chart review programs, vendor partnerships, and audit readiness
Maintain CMS compliance and audit-defensible documentation standards
Data, Analytics & Reporting
Partner with analytics teams to develop RAF dashboards and performance reporting
Interpret claims, encounter, and EMR data to identify gaps and opportunities
Provide regular performance updates to executive leadership
Support payer reporting and reconciliation efforts
Cross-Functional Leadership
Serve as the risk adjustment subject matter expert across the organization
Collaborate with Quality, Care Management, Finance, and IT teams
Support contract strategy and value-based care financial modeling
Drive continuous improvement initiatives and best-practice standardization
Experience
Required
Bachelor’s degree (clinical background preferred)
5+ years of experience in Medicare and Medicare Advantage risk adjustment
Strong working knowledge of CMS HCC models and documentation guidelines
Experience supporting provider education and clinical workflow optimization
Proven ability to manage distributed or offshore coding teams
Strong analytical, communication, and stakeholder management skills
US-based with availability to support provider and leadership engagement
Preferred
CRC, CPC, CCS, RN, or equivalent credential
Experience in value-based care, ACOs, or delegated risk arrangements
Experience with Revenue Cycle Management
Experience supporting both employed and affiliate provider networks
Familiarity with RAF forecasting and financial impact modeling
Apply To This Job