Senior Risk Adjustment Operations Associate

Devoted Health • Waltham, MA

10d • $58,000 - $83,000

About The Position

We are seeking a meticulous and technically skilled Operations Senior Associate to lead the intake and administrative phase of our risk adjustment external audit operational pipeline. This role is responsible for the front-end intake of retrieved medical documents, ensuring every document is accurately classified, appropriately split into unique encounters, and validated for eligibility before moving further into the evaluation process. This role supports audit operations and special projects. Audits include CMS Risk Adjustment Data Validation (RADV) audits and Part C Improper Payment Measurement audits. Special projects include implementing AI tools for automated data abstraction and document management. While your primary focus is on the early-stage audit pipeline, you will also serve as a key member of the External Audit Program team, supporting the end-to-end management of the entire audit lifecycle.

Requirements

• Proven experience as an operator who takes initiative with a strong problem-solving mindset and the ability to adapt to changing situations and requirements.
• Strong attention to detail with the ability to perform meticulous QA under time‑sensitive conditions.
• High degree of comfort pulling and analyzing data using spreadsheets, with experience or appetite to leverage database query tools.
• Ability to identify anomalies and troubleshoot technical errors and partner effectively with IT and technical teams.
• Strong organizational skills and experience managing high‑volume workflows with compressed timelines.
• Experience collaborating with offshore resources or distributed teams, with the ability to clearly communicate priorities and task requirements without direct managerial authority.
• Excellent communication and collaboration skills for working with cross-functional teams.

Nice To Haves

• Bachelor’s degree in Healthcare Administration, Health Information Management (HIM), Business, or related field. Relevant professional experience will be considered in lieu of a bachelor's degree.
• Familiarity with healthcare data (e.g., ICD‑10-CM medical diagnosis codes)
• Experience transforming operations through AI-enabled workflows

Responsibilities

• Manage the end-to-end administrative review process, including document triage, classification, and the technical execution of document management processes.
• Coordinate and direct day‑to‑day work activities of assigned team members for document‑related tasks, ensuring priorities, timelines, and quality standards are met; partner with Devoted’s internal management team to align assignments and resolve resource issues.
• Conduct detailed quality assurance checks to ensure accuracy of work output.
• Oversee and refine the use of AI-native tools for automated administrative information extraction to support the highest quality work of the team and process.
• Serve as a bridge between teams, providing rapid feedback on success and document quality to inform strategic pivots in audit approach.
• Partner closely with internal technology teams to resolve system issues and optimize processes.
• Prepare and deliver metrics, error trends, and resolution summaries for audit operations reporting; leverage AI, SQL, Looker, or other BI tools to extract and analyze workstream data where appropriate.
• Document and update standard operating procedures (SOPs) to ensure operational consistency.

Benefits

• Employer sponsored health, dental and vision plan with low or no premium
• Generous paid time off
• $100 monthly mobile or internet stipend
• Stock options for all employees
• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
• Parental leave program
• 401K program

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Associate degree