Manager - Risk Adjustment - Orange CountyDepartment: Quality - Risk Adjustment
Employment Type: Full Time
Location: 600 City Parkway West 10th Floor, Orange, CA 92868
Reporting To: Nallammai Vijayakumar
Compensation: $100,000 - $120,000 / year
DescriptionThe Manager, Risk Adjustment Programs is responsible for leading and overseeing risk adjustment operations and program execution within assigned markets, provider groups, or regions. This role is accountable for regional program performance, provider engagement, coding initiatives, chart review activities, and operational execution of established risk adjustment strategies. The Manager partners with clinical, quality, analytics, and operations leadership to ensure accurate risk capture, strong provider engagement, and sustained performance improvement within their assigned scope of responsibility. The role focuses on executing departmental priorities and operational excellence across designated markets and provider networks.
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.
