Risk Adjustment Supervisor

Position Summary:

The Risk Adjustment Supervisor is responsible for overseeing the performance and operational execution of risk adjustment activities across multiple lines of business, including Medicare Shared Savings Program (MSSP) ACO, REACH ACO, and Medicare Advantage. This role ensures that risk adjustment programs are effectively implemented and that coding accuracy, compliance, and quality standards are maintained to support appropriate revenue capture. The Risk Adjustment Supervisor serves as a subject matter expert and key liaison between internal teams and external partners, driving performance improvement initiatives aligned with CMS and payer-specific guidelines.

Key Responsibilities:

• Monitor and manage risk adjustment performance across MSSP ACO, REACH ACO, and Medicare Advantage populations.
• Analyze and interpret risk score trends, coding accuracy metrics, and clinical documentation to identify opportunities for improvement.
• Collaborate with clinical, data analytics, health information management (HIM), and provider engagement teams to enhance documentation and coding practices.
• Coordinate the implementation of risk adjustment strategies, including retrospective and prospective chart reviews, provider education.
• Ensure compliance with CMS risk adjustment guidelines, HCC coding standards, and payer contractual requirements.
• Work with external vendors or partners supporting risk adjustment functions, ensuring deliverables meet performance, quality, and compliance expectations.
• Prepare and present regular performance reports and updates to the Director of Revenue Cycle and other key stakeholders.
• Stay current with regulatory and policy changes impacting risk adjustment and communicate relevant updates to internal teams.
• Conducts face to face and virtual meetings with practice stakeholders as needed.

Qualifications:

Required:

• Associates Degree
• 3+ years of experience in risk adjustment, medical coding, or population health in a Medicare ACO and Medicare Advantage environment. REACH experience preferred.
• Strong knowledge of CMS-HCC V24 and V28 models, ICD-10 coding, and clinical documentation improvement.
• Experience with data analysis and interpreting risk adjustment-related metrics.

• Certified Risk Adjustment Coder (CRC)
• Familiarity with EHR systems and risk adjustment analytics platforms.
• Strong interpersonal and organizational skills with the ability to manage multiple priorities.