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