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Medicare Risk Adjustment Supervisor Jobs (NOW HIRING)

Mass Advantage

Manager, Risk Adjustment

Worcester, MA · On-site

Description Mass Advantage is a Medicare Advantage health plan, located in the heart of Worcester ... Risk Adjustment activities. This position is responsible for the strategy, execution and ...

BHC ISC

PBO Risk Adjustment Coding

Fort Lauderdale, FL · On-site

Review and audit documentation for appropriate capture of CAT II coding Medicare Annual Wellness ... High School or Equivalent Experience: 2-5 years of risk adjustment coding E/M procedures and ...

Centene

Risk Adjustment Auditor Educator

$56K - $101K/yr

... of Medicare risk adjustment (HCC Coding) Required Other experience in teaching, training or an educator/instructor role required; but provider education experience is preferred Preferred Other ...

Centene Corp.

$56K - $101K/yr

... of Medicare risk adjustment (HCC Coding) required. * Other experience in teaching, training or an educator/instructor role required; but provider education experience is preferred. * Other managed ...

Insight Global

Remote HCC Coder

Des Moines, IA · Remote

$19 - $22/hr

Day-to-Day Responsibilities Insight Global is seeking experienced HCC Risk Adjustment Medical Coders for a high-volume seasonal project supporting Medicare risk adjustment initiatives. Responsible ...

New

Insight Global

REMOTE HCC Coder

Denver, CO · Remote

$18 - $25/hr

Perform accurate HCC risk adjustment coding for Medicare populations * Review and code medical records in accordance with ICD and risk adjustment guidelines * Meet established quality standards and ...

Insight Global

Hcc Coders

Charlotte, NC · Remote

$18 - $21/hr

Insight Global is seeking experienced HCC Risk Adjustment Medical Coders for a high-volume seasonal project supporting Medicare risk adjustment initiatives. Responsible for coding 2 Charts per hour.

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Infographic showing various Medicare Risk Adjustment Supervisor job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 75% Full Time, 20% Part Time, 1% Temporary, 2% Contract, and 1% Nights. Highlights an 98% Physical, 1% Hybrid, and 1% Remote job distribution.

Manager, Risk Adjustment

Worcester, MA • On-site

Central Mass Health LLC
See more jobs at Central Mass Health LLCexternal

$90K/yr

Full-time

Re-posted 25 days ago

Job description

Mass Advantage is a Medicare Advantage health plan, located in the heart of Worcester County, headquartered in Worcester MA. Mass Advantage is owned and designed by UMass Memorial Health providers with their patients' needs in mind.
We are looking for a Manager of Risk Managment to oversee Mass Advantages's full suite of Risk Adjustment activities. This position is responsible for the strategy, execution and performance of Medicare risk adjustment programs, infrastructure and systems to meet business objectives, revenue expectations, management of external vendors, interaction with Providers, regulatory audits, and compliance with CMS regulations. The Manager of Risk Management is also responsible for analysis, projections, and assessment of Medicare revenue initiatives for senior products; leading and coordinating enterprise risk adjustment initiatives, working with the necessary areas of Mass Advantage and UMass Memorial Health Operations as well as vendor partners.
Essential Duties and Responsibilities:
Program Strategy & Execution
  • Own end-to-end RA strategy across prospective (point-of-care capture, suspecting, provider workflows) and retrospective (chart review, coding validation) programs, ensuring complete, accurate, and compliant HCC documentation under the applicable CMS-HCC model (including V24 -V28 transition management).
  • Evaluate current vendor performance, renegotiating or sunsetting SOWs where internal capability is superior.
  • Serve as the plan-side counterpart to UMMH CDI, HIM, and Coding leadership, coordinating with the CMO's office to embed documentation workflows into Epic-based clinical practice rather than layered on top of it.
  • Partner with Network and Clinical Services to design provider-facing education, scorecards, and incentive structures that drive documentation accuracy without creating coding-driven behavior.
  • Develop provider-level performance reporting that is transparent, defensible, and actionable.

RADV, Audit & Compliance
  • Lead RADV audit readiness and response, including medical record retrieval, validation, submission strategy, and cross-functional coordination with Legal, Compliance, and Finance to mitigate financial and compliance risk.
  • Maintain a comprehensive QA program covering RADV, OIG, and internal audits - monitoring the work of internal coders, contracted vendors, and provider documentation alike.
  • Own encounter data integrity, including EDPS submission accuracy, RAPS/EDPS reconciliation, and error resolution.

Analytics, Finance & Bid Support
  • Build and maintain the RA analytics layer - dashboards, KPIs, and provider/member-level reporting that drive continuous improvement in risk score accuracy, coding yield, and program ROI.
  • Partner with Actuarial and Finance on bid development, producing defensible risk score projections, trend analysis, and revenue assumptions grounded in population severity and program performance.
  • Communicate results to executive and board audiences through clear reports, dashboards, and presentations.

Program & Team Leadership
  • Set departmental goals, budgets, and tactical plans aligned with enterprise strategy and financial targets.
  • Other duties may be assigned as needed.

* Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
Requirements
  • Bachelor's degree in a relevant field; Master's (MBA, MHA, MPH) preferred.
  • Registered Nurse (RN) desired.
  • CRC (Certified Risk Adjustment Coder), CPC, or CCS certification preferred.
  • 7+ years in Medicare Advantage risk adjustment, with at least 3 years in a plan-side role (not solely provider-side or vendor-side).
  • Direct, hands-on RADV experience - working fluency with the CMS-HCC model, including the V24-V28 transition and its financial implications.
  • Demonstrated experience managing or transitioning RA vendors (coding, chart retrieval, in-home assessment).
  • Strong analytical skills: able to interrogate data directly in SQL, Power BI, or Tableau, or to spec analytics requirements with precision.+
  • Strong Microsoft Office skills (Word, Outlook, Excel and PP).

Salary Description
Starting at $90K

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