Manager, Risk Adjustment

Job not on LinkedIn

🕒 April 24

🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

💵 $90k / year

⏰ Full Time

🟠 Senior

🔴 Lead

🎲 Risk

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Mass Health

WebsiteLinkedInAll Job Openings

1 - 10 employees

⚕️ Healthcare Insurance

☁️ SaaS

Healthcare Insurance • SaaS

Mass Health is a company specializing in Remote Patient Monitoring (RPM) solutions designed to enhance patient care and streamline healthcare delivery. By leveraging advanced technology, Mass Health offers real-time monitoring, health analytics, and expert consultation services to improve patient outcomes, particularly for chronic conditions such as hypertension, diabetes, and heart disease. The company focuses on seamless integration with existing healthcare workflows, ensuring ease of use for healthcare providers and maintaining high standards of data security and compliance. Mass Health's innovative approach empowers healthcare practices to manage patient care more efficiently and effectively from a distance, transforming the landscape of digital healthcare.

📋 Description

• 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.

🎯 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).