Job Details

A company is looking for a Clinical Risk Adjustment Manager.Key ResponsibilitiesMonitor and interpret CMS, state Medicaid, and industry risk adjustment and quality regulationsProvide subject matter expert guidance to Product, Sales, and Account Management on risk adjustment policy and program implicationsEngage with industry groups to stay ahead of emerging trends and translate regulatory changes into actionable product recommendationsRequired QualificationsBachelor's degree in Healthcare Administration, Nursing, Health Information Management, or related clinical field5+ years of experience in Medicare Advantage risk adjustment, quality/HEDIS operations, or healthcare analyticsDeep knowledge of CMS-HCC risk adjustment models, RADV audits, and encounter data submission requirementsStrong understanding of Star Ratings methodology and quality improvement programsExperience interpreting CMS regulations and healthcare policy changes