Technical Product Manager – Medicare Risk Adjustment Solutions

Alignment Health • CA

77d • $113,332 - $169,999

About The Position

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. The Technical Product Manager position requires an individual to be a subject matter expert on Clinical platforms where the focus is on delivering better outcomes for Alignment members. This position will drive the strategy, roadmap, and delivery of Medicare's risk adjustment models. This role requires a combination of healthcare clinical and operational knowledge (especially Medicare Advantage), strong technical skills (e.g., SQL, data and document management platforms), and product management expertise to define roadmaps, manage data, and oversee technology solutions that ensure accurate risk score capture and compliance with Centers for Medicare & Medicaid Services (CMS) regulations.

Requirements

• 5+ years of Product Management or Business Analyst experience in healthcare payer systems, with at least 3 years focused on Medicare Advantage, ACA, HCC models, and related coding and documentation guidelines.
• Experience in healthcare operations, provider enablement, or working with health plans and risk adjustment vendors.
• Proven hands-on expertise with Microsoft SQL (querying, optimization, reconciliation, audits).
• Experience with ETL Tools such as Microsoft SSIS and Azure Data Factory.
• Experience with Cloud Platforms (Azure/AWS).
• Experience integrating vendor solutions.
• Solid understanding of what drives MRA accuracy and compliance in a Medicare environment.
• Strong analytical, problem-solving, and communication skills with the ability to translate technical details into business outcomes.

Nice To Haves

• MBA or advanced degree preferred.
• Deep understanding of Medicare Advantage, ACA, HCC models, and related coding and documentation guidelines.
• Proficiency in relevant technical tools, such as SQL, Azure Data Factory, Jira, Confluence, or specific risk adjustment analytics platforms.
• Experience in defining product strategies, managing product backlogs, and working within agile development methodologies.
• Familiarity with EDI standards and file protocols (HIPAA 837/835/820, XML, PDF fulfillment).
• Vendor management and SLA performance oversight.

Responsibilities

• Drive the functional and technical roadmap for risk adjustment systems, including provider engagement tools, data / document analytics platforms, and enterprise technology goals.
• Guide the technical implementation of risk adjustment solutions, potentially working with data platforms, ETL processes, and vendor integrations.
• Anticipate regulatory and operational changes (e.g., CMS rule updates, encounter data submission requirements) and integrate them into the roadmap.
• Ensure Alignment’s technical solutions address quality, accuracy, and completeness of data used for risk adjustment, often involving monitoring data submissions and addressing gaps.
• Collaborate with internal and external coding, analytics, and clinical teams to ensure accurate and complete diagnosis coding and HCC Gap Closures.
• Translate CMS regulations and Medicare operational requirements into actionable business and system requirements.
• Partner with vendors to manage technical solutions and integrations, ensuring compliance with service-level agreements (SLAs).
• Collaborate with various stakeholders, including clinical teams, provider groups, IT departments, actuarial services, and regulatory bodies, to align strategies and drive program success.
• Assist with CMS Risk Adjustment Data Validation activities to ensure our external physicians and Alignment Healthcare is prepared for and will pass an audit.

Benefits

• Equal Opportunity/Affirmative Action Employer.
• Opportunities for growth and innovation.
• Mission-focused team making high-quality, low-cost care a reality.

What This Job Offers

• Education Level: Bachelor's degree
• Number of Employees: 1,001-5,000 employees