Job Description
- Job Description:
- Drive the functional and technical roadmap for risk adjustment systems
- Guide the technical implementation of risk adjustment solutions
- Anticipate regulatory and operational changes and integrate them into the roadmap
- Ensure quality, accuracy, and completeness of data used for risk adjustment
- Collaborate with internal and external coding, analytics, and clinical teams
- Translate CMS regulations into actionable business and system requirements
- Partner with vendors to manage technical solutions and integrations
- Assist with CMS Risk Adjustment Data Validation activities
- Requirements:
- 5+ years of Product Management or Business Analyst experience in healthcare payer systems
- 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, ETL Tools, Cloud Platforms
- Strong analytical, problem-solving, and communication skills
- 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
- Benefits:
- Health insurance
- Retirement plans
- Professional development
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