Manager, Risk Adjustment
Employment type
Full-time
Work setting
On-site
Location
Worcester, MA
Schedule
Day shift
Posted
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Job overview
The Manager, Risk Adjustment is an onsite, full-time day-shift role in Worcester, MA. Compensation is not specified. The role oversees Mass Advantage’s Medicare risk adjustment activities and coordinates with UMass Memorial Health operations and provider partners.
What you'll do
- Lead prospective and retrospective risk adjustment strategy
- manage vendor performance
- coordinate documentation workflows with clinical, coding, and health information teams
- lead audit readiness and compliance
- oversee encounter data integrity
- build analytics and reporting
- support bid development and revenue projections
- and set departmental goals, budgets, and plans.
What we're looking for
- Skills & competencies
- risk adjustment managermedicare advantageradv auditscms-hccprovider documentationrisk analyticscomplianceworcester macentral mass healthumass memorial healthplan-side experiencerisk adjustment coding
- Work arrangement
- Weekend coverage required
Why this role
The posting requires seven or more years in Medicare Advantage risk adjustment, including at least three years in a plan-side role, and hands-on RADV experience. A relevant bachelor’s degree is required; a master’s degree, RN, and coding certifications are preferred.
About the employer
Central Mass Health LLC is hiring for this role. Industry: Direct Health and Medical Insurance Carriers. Sector: 52.
Additional details
- Industry sector
- 52
- Industry
- Direct Health and Medical Insurance Carriers
- Occupation code
- 11-9199.00
You'll be redirected to the employer's application page.
Listing ID: eafb6d34-4706-411d-86a2-107832d9fff5