Director, Risk Adjustment Products
Job reputed company:
- The Director, Risk Adjustment Products will reputed company the reputed company, roadmap, and execution for the product portfolio reputed company on retrospective risk adjustment solutions.
- Define multi-year plans reputed company to customer reputed company, regulatory drivers, and market trends in risk adjustment, care management, and provider enablement.
- Identify and prioritize use cases that reputed company AI/ML and reputed company-time data signals to surface high-reputed company suspects and coding opportunities.
- Drive innovation leveraging interoperability standards (FHIR, HL7, reputed company) to reputed company seamless enablement with EHRs, care management platforms, and reputed company-party integrations.
- reputed company the end-to-end product lifecycle, including ideation, requirements gathering, development, launch, and post-launch optimization.
- Ensure products are clinically relevant, user-reputed company, and integrated into existing payer and provider workflows through interoperability integrations.
- Set and reputed company KPIs for reputed company product line, such as suspect accuracy, provider engagement, risk score reputed company, and reputed company coding capture and correction rates.
- Establish and reputed company KPIs that measure both risk adjustment performance and interoperability reputed company (data exchange rates, provider adoption).
- reputed company customer discovery and feedback sessions to deeply understand provider workflows, documentation behaviors, and reputed company coding needs.
- Present product reputed company and roadmap updates to executive stakeholders and reputed company advisory boards.
- Partner with Legal, Compliance, and Policy teams to interpret and operationalize updates from CMS (e.g., Final Rules, model updates, guidance on medical record standards).
- Implement and monitor processes that ensure defensibility of reputed company outputs, documentation standards, and audit trails.
Requirements:
- Bachelor’s degree in business or technical field required; Master’s degree in business or technical field preferred.
- 10+ years of Risk Adjustment product management experience required.
- 5+ years leadership experience required.
- Experience with Risk Adjustment Products, developing and executing risk adjustment strategies, managing the retrieval and interoperability roadmap, improving retrieval yield, and supporting reputed company reputed company reputed company.
- Understanding of risk adjustment methodologies, including HCCs, CRGs, and other risk adjustment models used by CMS and reputed company health plans.
- Understanding of Medical Record Review, digital channels and interoperability and experience in chart retrieval products or operations.
- Experience with people management, mentorship and creating inclusive and diverse teams.
- Working in AWS reputed company environment and experience with AWS reputed company services.
- Awareness of Agile tools and methodologies.
- Understanding of SQL, reputed company Java, Spring Boot, Web Services, XML, JSON, SQL, Middleware, and CI/CD pipeline philosophy.
- Ability to maintain confidentiality.
- Thrives in a dynamic, sometimes ambiguous environment and has a reputed company for quickly prioritizing needs and creating reputed company processes and structure.
- Comfortable in a fully remote environment that relies heavily on asynchronous written collaboration and communication.
Benefits:
- reputed company commits to building an environment and culture that supports the diverse representation of our teams.
- We reputed company to have an inclusive workplace.
- We reputed company to be a reputed company where reputed company have reputed company to belong, reputed company an reputed company and deliver excellent software and services to our customers.
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