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Risk Adjustment Manager

The Risk Adjustment Manager position oversees the operation of all processes designed to improve Centers for Medicare and Medicaid Services (CMS) Risk Adjustment Payment System (RAPS). Under the direction of the CEO, this position also maintains an effective working and oversight relationship with both internal staff and vendors engaged in these processes. The Risk Adjustment Manager is also responsible for ensuring that staff and vendors comply with federal statues, state regulations, contractual agreements and Compliance policies and procedures relating to Risk Adjustment.

  • Define the scope of the RA project in collaboration with CEO and senior management.
  • Create a detailed work plan which identifies and sequences the activities needed to successfully complete the project.
  • Develop a schedule for project completion that effectively allocates resources to activities and objectives.
  • Provide Risk Adjustment Data Validation (RADV) support by contacting provider offices via phone to obtain required health records in order to meet the needs of auditors.
  • Manage deliverables and business owners including external vendors that support RA efforts, according to the established policies and practices of the organization.
  • Develop forms and records to document all risk adjustment related activities.
  • Attend RA specific regulatory meetings.
  • Conduct member outreach in order to promote preventive services & available incentives.
  • Recommend strategies to track programs and provide metrics to management.
  • Develop relationships with key provider offices as identified by management.
  • Keep current on all policy updates regarding ACA by working with internal and external information sources. Use information to adjust goals as necessary.
  • Assist with the development and implementation of new data optimization strategies by working with other departments to ensure consistent and reliable data.
  • Document progress and communicate progress to stakeholders including appropriate staff in the organization.
  • Evaluate the outcomes of the project as established during the planning phase.
  • Monitor changes to the RA program in collaboration with the Legal team and adjusts project accordingly.

  • Bachelor’s degree in Business or related field, plus 5 -10 years’ project management experience in a health plan or related environment.
  • Experience working with risk adjustment and/or ACA related programs.
  • Firm understanding of the MA and/or NH health insurance marketplace.
  • Understanding of state and federal regulations (the Affordable Care Act in particular) applicable to HMOs/PPOs.
  • Excellent problem solving and analytical skills.
  • Ability to innovate and thrive in a fast-paced, unstructured environment.
  • Excellent communication and consensus building skills.

Description of Company:

Minuteman Health is a new non-profit health insurance option for Massachusetts and New Hampshire residents. Founded by contributors that include Tufts Medical Center, Vanguard Health Systems and New England Quality Care Alliance (NEQCA), Minuteman offers consumers and employers lower-cost high-quality care with unprecedented transparency, as well as increased efficiency and satisfaction for physicians, patients, and employers alike.

*Please, NO recruiters or agencies



Accessibility: If you need an accommodation as part of the employment process please contact Human Resources at Email: careers@minutemanhealth.org

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