Risk Adjustment Program Lead

Job Title: Risk Adjustment Program LeadReports To: Vice President, MyTruAdvantageThe primary responsibility of the Risk Adjustment Program Lead is to serve as the subject matter expert for risk adjustment, maintaining oversight of all risk adjustment activities. This role will support Medicare Advantage and ACA risk adjustment programs.*Ideal candidates would be located in Indiana or surrounding states.Brief Description of Duties: Serve as the expert on Medicare Risk Adjustment models; monitor regulatory changes, ensuring adherence to CMS/HHS guidelinesDevelop and monitor metrics and KPIs to track the success of solutions and improvements; develop dashboards to share risk adjustment trends to key stakeholders; communicate risk adjustment impacts across all levels of the companyConduct comprehensive research and analysis to identify trends and areas of opportunity related to risk adjustment; contribute to the development and implementation of strategic initiatives and a risk adjustment work plan; collaborate with plan partners to leverage a lean team and all possible resources to improve risk adjustment outcomesResponsible for forecasting revenue and collaborating with finance teamCreate and maintain department policies and proceduresEnsure plan readiness and compliance for RAD-V and CMS auditsOwn vendor oversight of data integration and coding accuracy for Encounter Data Submissions and risk analyticsQualificationsMinimum Skills Requirement:Minimum of 5 years of experience in Medicare risk adjustmentStrong knowledge of CMS risk adjustment models/methodologies and HCC codingStrong analytical, organizational, problem-solving, vendor management, and critical thinking skillsAbility to work independently and manage multiple projects involving cross-functional teams and external vendorsAbility to interpret and analyze complex data and translate this into meaningful, actionable informationHigh standards of quality and accuracyAdvanced skills in Microsoft ExcelCommitment to maintaining confidentiality in compliance with HIPAA