Director, Risk Adjustment Products

Job Description:
• The Director, Risk Adjustment Products will lead the strategy, roadmap, and execution for the product portfolio focused on retrospective risk adjustment solutions.
• 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.
• Lead the end-to-end product lifecycle, including ideation, requirements gathering, development, launch, and post-launch optimization.
• 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).
• 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.

Requirements:
• 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.
• 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.

Benefits:
• HealthEdge commits to building an environment and culture that supports the diverse representation of our teams.
• We aspire to have an inclusive workplace.
• We aspire to be a place where all employees have the opportunity to belong, make an impact and deliver excellent software and services to our customers.

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