Overview

 

 

Director, Product Manager - Risk Adjustment

(Remote)

 

 

Responsibilities

About the Role:

• Type: Full-Time, Salaried

• Compensation: $152,000-$183,000, 20% bonus

• Location: Fully Remote (must be located in the United States)

• Hours: Full-Time, Days

• Benefits Offered: Medical, dental, vision, paid time off, paid holidays, 401(k) with company matching, voluntary life insurance, short-term disability, long-term disability, employee assistance program, health savings account, flexible spending accounts, and additional voluntary benefits.

What to Expect:

 

Every risk adjustment platform says they create a complete, accurate and compliant view of member health. We believe that's thinking too small. At Matrix, we're building technology that helps clinicians tell a more complete patient story, one that improves care, strengthens documentation, ensures regulatory compliance and creates measurable value for health plans and providers alike. If you're the kind of Product Leader who sees risk adjustment as a strategic advantage, not just a compliance exercise, we'd love to meet you. This isn't a role where you'll optimize one feature or own one backlog. You'll define how data, clinical workflows, AI, interoperability and mobile technology come together to reshape how millions of members are assessed across Medicare Advantage, ACA Marketplace and Medicaid. You'll own one of the most strategically important products in our portfolio. 

 

What You'll Build 

You'll lead product strategy for the technology that powers our Risk Adjustment ecosystem, including careflow™, Matrix's mobile platform used by Nurse Practitioners during in-home health assessments. 

 

Your mission centers around three product pillars: 

 

Enrich 

Create the industry's most complete member health picture. 

Bring together claims, clinical records, pharmacy, labs, supplemental data, HIEs and APIs into a unified view that equips clinicians before they ever knock on a patient's door. 

 

Capture 

Help clinicians document the right conditions the right way. Design intelligent assessments, clinical decision support, documentation prompts, conditional logic and AI-enabled workflows that improve clinically supported documentation while reducing provider burden. 

 

Measure 

Shape the future of clinically grounded, compliant, and member-centered risk adjustment.  Define the KPIs that matter, from documentation quality, clinical completeness, audit readiness, operational performance and recapture rates to documentation quality, first-pass yield, Actual vs. Expected disease burden and audit readiness, and make them visible to executives and clients alike. 

 

You'll Be Responsible For 

• Defining and executing the product roadmap across prospective and retrospective risk adjustment workflows 

• Building scalable capabilities supporting Medicare Advantage (CMS-HCC), ACA Marketplace (HHS-HCC), and Medicaid risk adjustment models 

• Driving enhancements inside careflow™ that improve clinician experience and documentation quality 

• Partnering with Clinical, Coding Operations, Engineering, Compliance, Finance, Customer Success and Executive Leadership 

• Translating evolving CMS regulations, including V28, RADV and Medicaid model changes, into product strategy before the market catches up 

• Leading build vs. buy decisions around AI-assisted coding, NLP, longitudinal patient records, audit analytics  and risk prediction platforms 

• Expanding interoperability through APIs, HIE integrations and FHIR-enabled data exchange 

• Defining the analytics and reporting that demonstrate measurable client value 

• Representing Product with customers and helping shape the future roadmap through real-world feedback 

 

Who You Are 

You're comfortable talking equally with software engineers, clinicians, coding experts, executives and health plan leaders. You understand that product management isn't about writing user stories. It's about solving meaningful business problems. You enjoy taking highly regulated, operationally complex healthcare processes and transforming them into elegant digital experiences. You're energized by difficult problems that don't have obvious answers. 

Qualifications

What You'll Bring 

 

Required

• 5+ years of Product Management experience 

• 2+ years working within healthcare payer, value-based care or Risk Adjustment 

• Deep understanding of HCC coding and CMS Risk Adjustment models across Medicare Advantage, ACA and Medicaid 

• Experience translating CMS regulatory changes into product strategy 

• Strong analytical skills with experience interpreting RAF performance, coding gaps, recapture metrics, encounter data and operational KPIs 

• Familiarity with APIs, HIEs, FHIR and healthcare interoperability 

• Demonstrated success leading highly cross-functional teams without direct authority 

• Confidence representing product strategy with customers and executive stakeholders 

 

Bonus Points 

 

You'll stand out if you've worked with: 

• AI or NLP-assisted coding platforms (Optum, Apixio, Episource, Veradigm, etc.) 

• Clinical Documentation Improvement (CDI) 

• Provider query workflows 

• HEDIS or Star 

• Value-Based Care organizations 

• Longitudinal patient data platforms 

• In-home clinical services 

 

What Success Looks Like After One Year 

Imagine looking back after your first year and knowing you helped transform how Risk Adjustment operates. 

 

You'll have: 

• Delivered meaningful enhancements to careflow™ that measurably improve clinician documentation and first-pass coding accuracy 

• Established the Enrich, Capture and Measure product strategy with clear ownership and execution milestones 

• Built reporting that clearly demonstrates RAF improvement, HCC capture, documentation quality and client value 

• Increased documentation quality, recapture performance and audit readiness across multiple lines of business 

• Delivered new interoperability capabilities that expand real-time data availability 

• Positioned the organization ahead of upcoming CMS regulatory changes instead of reacting to them 

 

Our Culture:

• We have a clear vision of where we are going, and we are guided by core values that embody our organization and our culture.
• We emphasizes innovation and growth, and you will be given the opportunities and tools to develop personally and professionally.
• We encourage and celebrate collaboration.
• We have a deep commitment to positively impact the communities in which we work and to make a difference in the lives of who we serve.

 

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