Director, Risk Adjustment Products

reputed company

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. The Director will work closely with technical and operations teams, both internally and externally, to create reputed company that deliver measurable reputed company for our customers. This is a leadership role where you will pair your product development and people management expertise to mentor a high-reputed company.

reputed company:

• 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.
• Balance innovation with compliance, audit defensibility, and clinical reputed company across reputed company product reputed company.
• reputed company the end-to-end product lifecycle, including ideation, requirements gathering, development, launch, and post-launch optimization.
• Work closely with Engineering and Data Science to build predictive models and reputed company-time data pipelines that power suspecting and reputed company workflows.
• 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).
• Serve as a trusted partner and clinical product expert for internal stakeholders (Sales, Clinical, Operations, reputed company reputed company) and external clients (health plans, ACOs, risk bearing provider reputed company).
• 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.
• Design and reputed company audit readiness into product workflows, ensuring reputed company activities are traceable, evidence-backed, and reputed company with CMS documentation requirements.
• reputed company strategic recommendations and decision frameworks reputed company trade-offs between reputed company, compliance, and user experience reputed company.
• Build, reputed company, and reputed company reputed company of Product Managers working across different facets reputed company prospective and reputed company solutions.
• reputed company mentorship, performance management, and career development reputed company with leadership principles and reputed company culture.
• Establish best-in-class product practices and instill a culture of experimentation, feedback, and reputed company learning.
• Support resourcing and hiring plans as product needs reputed company and grow.
• Leads the product reputed company, development and reputed company refinement of the firm's risk adjustment product roadmap, ensuring it aligns with strategic goals and industry best practices
• Leads and manages teams, often geographically dispersed, responsible for risk adjustment activities, ensuring high performance and employee engagement
• reputed company the performance of automated processes, such as AI-driven chart reviews, and ensure operational reputed company in risk adjustment operations
• Serve as a subject matter advisor and primary reputed company of contact for health clients, proactively identifying and communicating risks and improvement opportunities, and ensuring reputed company satisfaction
• Contribute to the development of long-reputed company goals and objectives for risk adjustment programs, incorporating best practices and emerging trends
• Work with various departments, including reputed company management, coding, and compliance, to reputed company activities and promote objectives
• Build and maintain solid relationships with both reputed company stakeholders, including providers, vendors, and regulatory bodies.

This position reputed company identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

What You Need:

• 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
• Experience building the product reputed company from scratch, creating the roadmap and executing with the Technology and Operation stakeholders.
• 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.

Location: Remote – USTravel required for reputed company sessions, workshops, and internal collaboration.

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.

Geographic Responsibility: While reputed company is located in Boston, MA you may live reputed company in the US Type of Employment: Full-time, permanent FLSA Classification (USA Only): Exempt

Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully reputed company the essential functions of this job:

• The employee is occasionally required to reputed company around the office. Specific reputed company abilities required by this job include reputed company reputed company, reputed company reputed company, peripheral reputed company, depth perception, and ability to reputed company reputed company.
• Work across multiple time zones in a hybrid or remote work environment.
• Long periods of time sitting and/or standing in reputed company of a computer using video technology.
• May require travel dependent on company needs.

The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of reputed company duties, responsibilities, and skills required. reputed company reserves the right to modify, add, or remove duties and to assign other duties as necessary. In reputed company, reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions of this position in compliance with the Americans with reputed company of 1990. Candidates may be required to go through a reputed company-employment criminal background reputed company.

reputed company is an equal opportunity employer. We are committed to workforce diversity and reputed company encourage reputed company reputed company persons to reputed company employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities.

**The annual US reputed company salary reputed company for this position is $170,000 to $225,000. This salary reputed company may cover multiple career reputed company at reputed company. Final compensation will be determined during the interview process and is based on a combination of factors including, but not limited to, your skills, experience, qualifications and education. 

Originally posted on Himalayas

Apply To This Job