Technical Product Manager – Medicare Risk Adjustment Solutions

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:• bolthires SQL (querying, optimization, reconciliation, audits)• ETL Tools such as bolthires 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 Apply tot his job