We are seeking a Product Manager to lead Risk Adjustment product capabilities across all lines of business, including Medicare Advantage, ACA Marketplace, and Medicaid.
This role owns the execution and evolution of Risk Adjustment solutions within our population health platform, ensuring accurate risk capture, compliant submissions, and efficient coding workflows for health plans and provider organizations.
The Product Manager will work closely with engineering, clinical coding teams, operations, and customer success teams, while collaborating with the Head of Platform on overall product strategy and roadmap direction.
Responsibilities:
Risk Adjustment Product Ownership
Own development and management of core Risk Adjustment capabilities including:
- HCC model updates and configuration
- Risk score computation across supported models
- Suspect generation and accuracy management
- Encounter data reconciliation
- Risk adjustment reporting and analytics
Ensure platform support for
- Medicare Advantage (CMS-HCC)
- ACA Marketplace (HHS-HCC)
- Medicaid risk adjustment models
Regulatory & Program Monitoring
- Track CMS announcements and regulatory updates
- Ensure timely platform updates aligned with HCC model changes
- Monitor LOB-specific submission timelines and program requirements
- Work closely with clinical coding teams and outbound operations teams to support operational readiness
Product Development & Enhancements
- Identify and define new feature enhancements
- Design product workflows and requirements
- Maintain and prioritize product backlog
- Work with engineering teams and TPMs to track development progress
- Validate completed features prior to release
Client & Customer Success Collaboration
- Work closely with Customer Success teams to understand client workflows and challenges
- Participate in client discussions when needed
- Translate client feedback into product improvements and roadmap priorities
Product Strategy Collaboration
- Work in close collaboration with the Head of Platform to align Risk Adjustment capabilities with overall platform strategy
- Provide domain expertise and product insights to inform roadmap planning