Risk Adjustment Senior Manager

Accenture • Philadelphia, PA

14d

About The Position

Accenture is a leading global professional services company that helps the world’s leading businesses, governments and other organizations build their digital core, optimize their operations, accelerate revenue growth and enhance citizen services—creating tangible value at speed and scale. We are a talent- and innovation-led company with approximately 750,000 people serving clients in more than 120 countries. Technology is at the core of change today, and we are one of the world’s leaders in helping drive that change, with strong ecosystem relationships. We combine our strength in technology and leadership in cloud, data and AI with unmatched industry experience, functional expertise and global delivery capability. We are uniquely able to deliver tangible outcomes because of our broad range of services, solutions and assets across Strategy & Consulting, Technology, Operations, Industry X and Song. These capabilities, together with our culture of shared success and commitment to creating 360° value, enable us to help our clients reinvent and build trusted, lasting relationships. We measure our success by the 360° value we create for our clients, each other, our shareholders, partners and communities. Visit us at www.accenture.com . Strategy & Consulting: We work with C-suite executives, leaders and boards of the world’s leading organizations, helping them reinvent every part of their enterprise to drive greater growth, enhance competitiveness, implement operational improvements, reduce cost, deliver sustainable 360° stakeholder value, and set a new performance frontier for themselves and the industry in which they operate. Our deep industry and functional expertise is supported by proprietary assets and solutions that help organizations transform faster and become more resilient. Underpinned by technology, data, analytics, AI, change management, talent and sustainability capabilities, our Strategy & Consulting services help architect and accelerate all aspects of an organization’s total enterprise reinvention. As a Risk Adjustment Operations Leader, your primary responsibilities may include:

Requirements

• Bachelor’s degree in Business Administration , Health Administration, Information Technology, or related field preferred.
• A minimum of 5 years of experience in healthcare consulting, or risk management operations with a health plan or risk adjustment service provider.
• A minimum of 5 years of experience planning, securing funding for, and executing a roadmap for continual improvement of risk adjustment capabilities .

Nice To Haves

• Master’s degree preferred.
• Experience working with or leading global teams.
• Thrive in a diverse, fast paced environment.
• Exceptional problem-solving and analytical skills.
• Excellent communication and presentation abilities.
• Leadership experience, including team management and project oversight.
• Experience leveraging automation for medical chart capture and AI for supporting medical chart reviews.
• Experience presenting operational and financial impacts of risk adjustment services to health plan leadership.
• Participated in CMS compliance audits.
• Certified medical coder.

Responsibilities

• Product Roadmap Development and Maintenance Lead the development and continuous refinement of the firm’s r isk a djustment product roadmap. Ensure the product offering leverages cutting-edge technology, including AI-driven chart reviews and advanced analytics.
• Performance Management Establish and oversee performance management processes, ensuring operational excellence and superior client outcomes. Develop and maintain reporting frameworks to monitor performance metrics, identifying areas for improvement.
• Client Management Serve as the subject matter advisor and primary point of contact for health clients for risk adjustment services . Proactively identify and communicate risks, issues, and improvement opportunities to clients. Set and manage client expectations, ensuring satisfaction and alignment with service objectives .
• Regulatory Compliance Monitor regulatory changes, including CMS and HHS guidelines, and ensure risk adjustment services remain compliant. Oversee enhancements to processes and tools in response to evolving regulatory requirements.
• Operational Excellence Oversee the performance of automated processes, including AI-based chart reviews and risk adjustment analytics. Identify opportunities to improve speed, breadth, and accuracy of risk adjustment operations.
• Business Development Support sales initiatives, contributing to proposals and presentations to secure new clients. Leverage industry insights to identify growth opportunities and expand the firm’s risk adjustment client base.
• Team Leadership Build, mentor, and provide strategic direction to a team of junior resources. Foster a culture of continuous improvement, ensuring the team delivers high-quality, efficient services.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees