Alignment Health

Compensation

Full Description

Job Description: • Drive the functional and technical roadmap for risk adjustment systems, including provider engagement tools, data / document analytics platforms, and enterprise technology goals. • Guiding 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. • Ensuring 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). • Collaborating with various stakeholders, including clinical teams, provider groups, IT departments, actuarial services, and regulatory bodies, to align strategies and drive program success. • Assists with CMS Risk Adjustment Data Validation activities to ensure our external physicians and Alignment Healthcare is prepared for and will pass an audit. Requirements: • 5+ years of Product Management or Business Analyst experience in healthcare payer systems • 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) • ETL Tools such as Microsoft SSIS and Azure Data Factory • 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. • Bachelor’s degree in Information Systems, Computer Science, Business, Healthcare Administration, or related field • 4 years additional experience may be considered in lieu of education • MBA or advanced degree preferred. Benefits: • Health insurance • 401(k) matching • Flexible work hours • Paid time off • Remote work options