What is a risk adjustment manager?

A Risk Adjustment Manager is a professional who oversees the processes that ensure healthcare organizations accurately report patient diagnoses and health conditions for risk adjustment purposes. They manage teams and systems responsible for collecting, analyzing, and submitting data to regulatory agencies and insurers. Their work helps healthcare organizations receive appropriate reimbursement by aligning payments with the predicted cost of patient care based on risk factors. Risk Adjustment Managers also ensure compliance with government regulations and help implement best practices in data accuracy and quality. This role often involves collaboration with coding, clinical, and IT teams.