[Hiring] Director, Risk Adjustment Products @HealthEdge

Role Description

The Director, Risk Adjustment Products will lead the strategy, roadmap, and execution for the product portfolio focused on retrospective risk adjustment solutions. This is a leadership role where you will pair your product development and people management expertise to mentor a high-performance team.

• Define multi-year plans aligned to customer outcomes, regulatory drivers, and market trends in risk adjustment, care management, and provider enablement.
• Identify and prioritize use cases that leverage AI/ML and real-time data signals to surface high-impact suspects and coding opportunities.
• Drive innovation leveraging interoperability standards (FHIR, HL7, APIs) to enable seamless enablement with EHRs, care management platforms, and third-party integrations.
• Balance innovation with compliance, audit defensibility, and clinical integrity across all product decisions.
• Lead the end-to-end product lifecycle, including ideation, requirements gathering, development, launch, and post-launch optimization.
• Work closely with Engineering and Data Science to build predictive models and real-time data pipelines that power suspecting and concurrent workflows.
• Ensure products are clinically relevant, user-centric, and integrated into existing payer and provider workflows through interoperability integrations.
• Set and track KPIs for each product line, such as suspect accuracy, provider engagement, risk score impact, and concurrent coding capture and correction rates.
• Establish and track KPIs that measure both risk adjustment performance and interoperability success (data exchange rates, provider adoption).
• Serve as a trusted partner and clinical product expert for internal stakeholders (Sales, Clinical, Operations, Client Success) and external clients (health plans, ACOs, risk bearing provider groups).
• Lead customer discovery and feedback sessions to deeply understand provider workflows, documentation behaviors, and concurrent coding needs.
• Present product strategy and roadmap updates to executive stakeholders and client advisory boards.
• Partner with Legal, Compliance, and Policy teams to interpret and operationalize updates from CMS (e.g., Final Rules, model updates, guidance on medical record standards).
• Implement and monitor processes that ensure defensibility of all outputs, documentation standards, and audit trails.
• Design and embed audit readiness into product workflows, ensuring all activities are traceable, evidence-backed, and aligned with CMS documentation requirements.
• Provide strategic recommendations and decision frameworks when trade-offs between revenue, compliance, and user experience arise.
• Build, lead, and coach a team of Product Managers working across different facets within prospective and concurrent solutions.
• Provide mentorship, performance management, and career development aligned with leadership principles and growth culture.
• Establish best-in-class product practices and instill a culture of experimentation, feedback, and continuous learning.
• Support resourcing and hiring plans as product needs evolve and grow.
• Leads the product strategy, development and continuous refinement of the firm's risk adjustment product roadmap, ensuring it aligns with strategic goals and industry best practices.
• Leads and manages teams, often geographically dispersed, responsible for risk adjustment activities, ensuring high performance and employee engagement.
• Oversee the performance of automated processes, such as AI-driven chart reviews, and ensure operational excellence in risk adjustment operations.
• Serve as a subject matter advisor and primary point of contact for health clients, proactively identifying and communicating risks and improvement opportunities, and ensuring client satisfaction.
• Contribute to the development of long-range goals and objectives for risk adjustment programs, incorporating best practices and emerging trends.
• Work with various departments, including revenue management, coding, and compliance, to align activities and promote objectives.
• Build and maintain solid relationships with both internal and external stakeholders, including providers, vendors, and regulatory bodies.

Qualifications

• Bachelor’s degree in business or technical field required; Master’s degree in business or technical field preferred.
• 10+ years of Risk Adjustment product management experience required.
• 5+ years leadership experience required.
• Experience with Risk Adjustment Products, developing and executing risk adjustment strategies, managing the retrieval and interoperability roadmap, improving retrieval yield, and supporting commercial client growth.
• Experience building the product strategy from scratch, creating the roadmap and executing with the Technology and Operation stakeholders.
• Understanding of risk adjustment methodologies, including HCCs, CRGs, and other risk adjustment models used by CMS and commercial health plans.
• Understanding of Medical Record Review, digital channels and interoperability and experience in chart retrieval products or operations.
• Experience with people management, mentorship and creating inclusive and diverse teams.
• Working in AWS cloud environment and experience with AWS cloud services.
• Awareness of Agile tools and methodologies.
• Understanding of SQL, Core Java, Spring Boot, Web Services, XML, JSON, SQL, Middleware, and CI/CD pipeline philosophy.
• Ability to maintain confidentiality.
• Thrives in a dynamic, sometimes ambiguous environment and has a knack for quickly prioritizing needs and creating scalable processes and structure.
• Comfortable in a fully remote environment that relies heavily on asynchronous written collaboration and communication.

Location

• Remote – US
• Travel required for client sessions, workshops, and internal collaboration.

Type of Employment

• Full-time, permanent
• FLSA Classification (USA Only): Exempt

Work Environment

• The employee is occasionally required to move around the office.
• Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
• Work across multiple time zones in a hybrid or remote work environment.
• Long periods of time sitting and/or standing in front of a computer using video technology.
• May require travel dependent on company needs.

Salary

The annual US base salary range for this position is $170,000 to $225,000. This salary range may cover multiple career levels at HealthEdge. Final compensation will be determined during the interview process and is based on a combination of factors including, but not limited to, your skills, experience, qualifications, and education.