Job Description Summary

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The Manager of Risk Adjustment Implementation is responsible for coordinating and executing key risk adjustment programs that support accurate HCC capture, documentation quality, and compliance across Medicare Advantage, ACA, and other value-based care models. This role manages day-to-day operational workflows, supports cross-functional implementation efforts, and ensures programs run efficiently and effectively.

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How will you make an impact & Requirements

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Key Responsibilities

Program Implementation & Execution

• Lead the end-to-end implementation of risk adjustment initiatives, including prospective and retrospective review programs, suspect condition workflows, and clinical documentation improvement efforts.
• Build and manage implementation roadmaps, timelines, and success metrics for each program.
• Ensure operational consistency, quality, and compliance across all markets and lines of business.

Operational Leadership

• Oversee day-to-day operations for risk adjustment workflows, ensuring accuracy, productivity, and process adherence.
• Identify opportunities to streamline or standardize processes to improve efficiency and outcomes.

Cross-Functional Collaboration

• Work closely with Clinical, Coding, Analytics, Operations, and Technology teams to align program requirements and support enterprise-wide initiatives.
• Collaborate with provider leadership to drive documentation accuracy and adoption of workflow changes.

Data-Driven Performance Management

• Partner with analytics teams to monitor HCC prevalence, RAF impact, coding accuracy, and operational KPIs.
• Use data insights to identify gaps, recommend improvements, and adjust programs in real time.

Provider Engagement & Education

• Support the development and delivery of provider education on documentation best practices and HCC model requirements.
• Ensure providers have tools, workflows, and clarity needed to accurately reflect patient complexity.

Regulatory & Compliance Oversight

• Ensure all risk adjustment activities comply with CMS and HHS regulations, coding requirements, and audit standards.
• Maintain awareness of model changes, policy updates, and documentation guidelines.