Manager - Risk Adjustment - Orange County

Description

• Put Patients First 
• Empower Entrepreneurial Provider and Care Teams 
• Operate with Integrity & Excellence 
• Be Innovative 
• Work As One Team 

What You'll Do

• Lead end-to-end execution of risk adjustment programs, including retrospective and prospective chart reviews, annual wellness visits, coding optimization, and documentation improvement initiatives.
• Oversee program timelines, deliverables, resources, and performance across assigned regions, markets, and provider networks, ensuring alignment with enterprise risk adjustment strategies and organizational goals.
• Implement enterprise initiatives, manage regional provider incentive and engagement programs, and drive process improvements to enhance operational efficiency, accuracy, and scalability.
• Directly manage supervisors, coordinators, and vendor partners, providing leadership through coaching, hiring, onboarding, performance management, workforce planning, and team development.
• Partner with providers, clinic leadership, and medical groups to improve documentation accuracy, coding performance, and risk score capture through provider education, training, and engagement initiatives.
• Monitor key performance indicators, including RAF performance, coding accuracy, audit results, chart review productivity, retrieval rates, and program completion. Develop performance reports, identify gaps, and implement corrective action plans.
• Provide regular performance updates and strategic insights to senior leadership, recommending improvements to address operational challenges and optimize market outcomes.
• Ensure compliance with CMS guidelines, regulatory requirements, and internal policies through oversight of coding audits, validation, and quality assurance activities.
• Collaborate with analytics, clinical leadership, quality, and population health teams to align risk adjustment initiatives, support enterprise projects, and drive continuous improvement.
• Other duties as assigned. 

Qualifications

• Bachelor's degree in Healthcare Administration, Public Health, Business Administration, Nursing, Health Information Management, or a related field.
• 5–7 years of experience in risk adjustment, coding, healthcare operations, or managed care, including 2–3 years of progressive leadership experience managing supervisors or team leads.
• Experience supporting risk adjustment programs in IPA, MSO, or health plan environments, preferably with responsibility for operational teams across a defined market, region, or provider network.
• Preferred certifications: CRC, CPC, CCS, RHIA, RHIT, or equivalent.
• Strong knowledge of CMS-HCC risk adjustment methodologies, provider documentation standards, coding requirements, and applicable regulatory guidelines.
• Demonstrated ability to lead operational teams, drive performance outcomes, manage complex programs, and coordinate multiple stakeholders.
• Strong analytical skills with the ability to evaluate performance metrics, identify opportunities, and implement process improvements.
• Excellent communication, relationship management, organizational, problem-solving, and decision-making skills.
• Proficiency in Microsoft Office and healthcare systems.

Environmental Job Requirements and Working Conditions

• This is a full-time, hybrid position, where you will be expected to work from home and also travel to provider office throughout Orange County. 
• The national target compensation for this position is $100,000 - $120,000 per year. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.