Vendor Jobs

About The Position

Requirements

• Bachelor’s degree (clinical background preferred)
• 5+ years of experience in Medicare and Medicare Advantage risk adjustment
• Strong working knowledge of CMS HCC models and documentation guidelines
• Experience supporting provider education and clinical workflow optimization
• Proven ability to manage distributed or offshore coding teams
• Strong analytical, communication, and stakeholder management skills
• US-based with availability to support provider and leadership engagement

Nice To Haves

• CRC, CPC, CCS, RN, or equivalent credential
• Experience in value-based care, ACOs, or delegated risk arrangements
• Experience with Revenue Cycle Management
• Experience supporting both employed and affiliate provider networks
• Familiarity with RAF forecasting and financial impact modeling

Responsibilities

• Own the end-to-end implementation of Medicare and Medicare Advantage risk adjustment strategy, including prospective, concurrent, and retrospective models
• Establish annual RAF targets, forecasts, and performance monitoring cadence
• Translate CMS HCC guidance into actionable clinical and coding workflows
• Monitor coding intensity, suspect capture rates, and year-over-year RAF trends
• Partner with providers to improve documentation accuracy and chronic condition capture
• Lead provider education on risk adjustment, HCCs, and compliant documentation practices
• Collaborate with Provider Relations and Clinical Leadership to embed workflows into daily practice
• Support employed and affiliate clinics with tailored engagement strategies
• Oversee coding workflows across internal and offshore teams
• Ensure quality assurance processes are in place for coding accuracy and compliance
• Coordinate chart review programs, vendor partnerships, and audit readiness
• Maintain CMS compliance and audit-defensible documentation standards
• Partner with analytics teams to develop RAF dashboards and performance reporting
• Interpret claims, encounter, and EMR data to identify gaps and opportunities
• Provide regular performance updates to executive leadership
• Support payer reporting and reconciliation efforts
• Serve as the risk adjustment subject matter expert across the organization
• Collaborate with Quality, Care Management, Finance, and IT teams
• Support contract strategy and value-based care financial modeling
• Drive continuous improvement initiatives and best-practice standardization