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Manager, Risk Adjustment
Location
Massachusetts
Posted
35 days ago
Salary
$90K / year
Seniority
Lead
Job Description
Manager, Risk Adjustment
Mass Health
• Oversee Mass Advantage's risk adjustment activities and strategy. • Execute Medicare risk adjustment programs to fulfill business objectives. • Manage external vendors and conduct regulatory audits and compliance. • Analyze Medicare revenue initiatives for senior products. • Coordinate risk adjustment initiatives across departments and provider partners.
Job Requirements
- Bachelor's degree in a relevant field; Master's (MBA, MHA, MPH) preferred.
- Registered Nurse (RN) desired.
- CRC (Certified Risk Adjustment Coder), CPC, or CCS certification preferred.
- 7+ years in Medicare Advantage risk adjustment, with at least 3 years in a plan-side role (not solely provider-side or vendor-side).
- Direct, hands-on RADV experience - working fluency with the CMS-HCC model, including the V24-V28 transition and its financial implications.
- Demonstrated experience managing or transitioning RA vendors (coding, chart retrieval, in-home assessment).
- Strong analytical skills: able to interrogate data directly in SQL, Power BI, or Tableau, or to spec analytics requirements with precision.
- Strong Microsoft Office skills (Word, Outlook, Excel and PP).
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