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Risk Adjustment Program Manager
RCM Healthcare Services
compensation:
$125000 to $145000 per year
job title:
Risk Adjustment Program Manager
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Risk Adjustment Program ManagerNew York, NY (Hybrid) | $125,000 to $145,000
A leading not-for-profit health plan is seeking a Risk Adjustment Program Manager to support risk adjustment initiatives across Medicare, Medicaid, and Exchange populations.
Hybrid: 2 days a week in the NYC office and 3 days a week remote. This could possibly become 100% remote in the future.
Responsibilities:
- Ensure accuracy of encounter submissions and resolve data discrepancies
- Identify and close risk score gaps through data analysis and provider collaboration
- Analyze program performance and refine risk adjustment strategies
- Oversee reporting, analytics, and vendor performance
- Ensure compliance with CMS and state regulations
- Lead projects, including RFPs and vendor implementations
- Supervise and mentor analysts
- Bachelor’s degree required (Master’s preferred)
- 6+ years healthcare experience, including 3+ years in Risk Adjustment
- Knowledge of risk models (CMS-HCC, HHS-HCC, 3M CRG)
- Strong analytical skills (SQL or similar preferred)
- Experience in health plan, provider, or vendor environment
#AC1
#ACP
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- Principals only. Recruiters, please don't contact this job poster.