Technical Product Manager – Medicare Risk Adjustment Solutions
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first.We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
The Technical Product Manager position requires an individual to be a subject matter expert on Clinical plat-forms where the focus is on delivering better outcomes for Alignment members. This position will drive the strategy, roadmap, and delivery of Medicare's risk adjustment models. This role requires a combination of healthcare clinical and operational knowledge (especially Medicare Advantage), strong technical skills (e.g., SQL, data and document management platforms), and product management expertise to define roadmaps, manage data, and oversee technology solutions that ensure accurate risk score capture and compliance with Centers for Medicare & Medicaid Services (CMS) regulations.Job Duties/Responsibilities:
• Drive the functional and technical roadmap for risk adjustment systems, including provider engagement tools, data / document analytics platforms, and enterprise technology goals.
• Guiding the technical implementation of risk adjustment solutions, potentially working with data platforms, ETL processes, and vendor integrations.
• Anticipate regulatory and operational changes (e.g., CMS rule updates, encounter data submission requirements) and integrate them into the roadmap.
• Ensuring Alignment’s technical solutions address quality, accuracy, and completeness of data used for risk adjustment, often involving monitoring data submissions and addressing gaps.
• Collaborate with internal and external coding, analytics, and clinical teams to ensure accurate and complete diagnosis coding and HCC Gap Closures.
• Translate CMS regulations and Medicare operational requirements into actionable business and system requirements.
• Partner with vendors to manage technical solutions and integrations, ensuring compliance with service-level agreements (SLAs).
• Collaborating with various stakeholders, including clinical teams, provider groups, IT departments, actuarial services, and regulatory bodies, to align strategies and drive program success.
• Assists with CMS Risk Adjustment Data Validation activities to ensure our external physicians and Alignment Healthcare is prepared for and will pass an audit.
Job Requirements:
Experience:
• 5+ years of Product Management or Business Analyst experience in healthcare payer systems, with at least 3 years focused on Medicare Advantage, ACA, HCC models, and related coding and documentation guidelines.
• Experience in healthcare operations, provider enablement, or working with health plans and risk adjustment vendors.
• Proven hands-on expertise with:
• Microsoft SQL (querying, optimization, reconciliation, audits)
• ETL Tools such as Microsoft SSIS and Azure Data Factory
• Cloud Platforms (Azure/AWS)
• Experience integrating vendor solutions
• Solid understanding of what drives MRA accuracy and compliance in a Medicare environment.
• Strong analytical, problem-solving, and communication skills with the ability to translate technical details into business outcomes.
Education:
• Bachelor’s degree in Information Systems, Computer Science, Business, Healthcare Administration, or related field. 4 years additional experience may be considered in lieu of education
• MBA or advanced degree preferred.
Specialized Skills:
• Deep understanding of Medicare Advantage, ACA, HCC models, and related coding and documentation guidelines
• Proficiency in relevant technical tools, such as SQL, Azure Data Factory, Jira, Confluence, or specific risk adjustment analytics platforms
• Experience in defining product strategies, managing product backlogs, and working within agile development methodologies.
• Familiarity with EDI standards and file protocols (HIPAA 837/835/820, XML, PDF fulfillment).
• Vendor management and SLA performance oversight.
Pay Range: $113,332.00 - $169,999.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.
• DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].
Apply Now
Apply Now
The Technical Product Manager position requires an individual to be a subject matter expert on Clinical plat-forms where the focus is on delivering better outcomes for Alignment members. This position will drive the strategy, roadmap, and delivery of Medicare's risk adjustment models. This role requires a combination of healthcare clinical and operational knowledge (especially Medicare Advantage), strong technical skills (e.g., SQL, data and document management platforms), and product management expertise to define roadmaps, manage data, and oversee technology solutions that ensure accurate risk score capture and compliance with Centers for Medicare & Medicaid Services (CMS) regulations.Job Duties/Responsibilities:
• Drive the functional and technical roadmap for risk adjustment systems, including provider engagement tools, data / document analytics platforms, and enterprise technology goals.
• Guiding the technical implementation of risk adjustment solutions, potentially working with data platforms, ETL processes, and vendor integrations.
• Anticipate regulatory and operational changes (e.g., CMS rule updates, encounter data submission requirements) and integrate them into the roadmap.
• Ensuring Alignment’s technical solutions address quality, accuracy, and completeness of data used for risk adjustment, often involving monitoring data submissions and addressing gaps.
• Collaborate with internal and external coding, analytics, and clinical teams to ensure accurate and complete diagnosis coding and HCC Gap Closures.
• Translate CMS regulations and Medicare operational requirements into actionable business and system requirements.
• Partner with vendors to manage technical solutions and integrations, ensuring compliance with service-level agreements (SLAs).
• Collaborating with various stakeholders, including clinical teams, provider groups, IT departments, actuarial services, and regulatory bodies, to align strategies and drive program success.
• Assists with CMS Risk Adjustment Data Validation activities to ensure our external physicians and Alignment Healthcare is prepared for and will pass an audit.
Job Requirements:
Experience:
• 5+ years of Product Management or Business Analyst experience in healthcare payer systems, with at least 3 years focused on Medicare Advantage, ACA, HCC models, and related coding and documentation guidelines.
• Experience in healthcare operations, provider enablement, or working with health plans and risk adjustment vendors.
• Proven hands-on expertise with:
• Microsoft SQL (querying, optimization, reconciliation, audits)
• ETL Tools such as Microsoft SSIS and Azure Data Factory
• Cloud Platforms (Azure/AWS)
• Experience integrating vendor solutions
• Solid understanding of what drives MRA accuracy and compliance in a Medicare environment.
• Strong analytical, problem-solving, and communication skills with the ability to translate technical details into business outcomes.
Education:
• Bachelor’s degree in Information Systems, Computer Science, Business, Healthcare Administration, or related field. 4 years additional experience may be considered in lieu of education
• MBA or advanced degree preferred.
Specialized Skills:
• Deep understanding of Medicare Advantage, ACA, HCC models, and related coding and documentation guidelines
• Proficiency in relevant technical tools, such as SQL, Azure Data Factory, Jira, Confluence, or specific risk adjustment analytics platforms
• Experience in defining product strategies, managing product backlogs, and working within agile development methodologies.
• Familiarity with EDI standards and file protocols (HIPAA 837/835/820, XML, PDF fulfillment).
• Vendor management and SLA performance oversight.
Pay Range: $113,332.00 - $169,999.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.
• DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].
Apply Now
Apply Now