Product Manager, Risk Adjustment Solutions

Job Description

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 

Requirements

• 5+ years Product Management experience 

• 5+ years experience with Risk Adjustment or Population Health technology 

• Strong understanding of Medicare Advantage, ACA, or Medicaid risk programs 

• Familiarity with HCC models and coding workflows 

• Experience collaborating with engineering teams on healthcare platforms 

Competencies:  

Communicates Effectively 

• Exchanging ideas, knowledge, and data so that the message is received and understood with clarity and purpose.  

• Leverages emotional intelligence to adapt to the emotions and intentions of others. 

Plans and Aligns, Resourcefulness 

• Plans and prioritizes work to meet the goals of the business.  

• Breaks down objectives into plans and actions to achieve significant milestones.  

• Anticipates and readily adjusts plans.  

• Maintains organization of resources to support efficiency. 

Business Insight & Organizational Savvy 

• Ensures work and tasks are aligned to meet company priorities.  

• Breaks down goals into actions with milestones.  

• Understands how to navigate the company and connect with key stakeholders or contributors. 

Collaborates 

• Identifies and builds partnerships to meet shared goals.  

• Readily partners with others to meet objectives and shares credit for contributions.  

• Demonstrates cooperation that earns support of others. 

Balances Stakeholders & Manages Conflict 

• Anticipating and balancing the needs of multiple stakeholders and multiple projects.  

• Highly prepared and knowledgeable about expectations.  

• Delivers fair and flexible response to stakeholder needs.  

• Handling conflict situations to resolution effectively and professionally.  

• Applies fair decision-making to balance competing interest mediating any points of abrasion. 

Situational Adaptability & Flexibility 

• Adapts approach in real time to respond to different situations.  

• Thinks quickly and readily adapts behavior in the moment.  

• High level of versatility. 

Benefits

WORKING AT VATICA HEALTH ADVANTAGES

Prosperity

• Competitive salary based on your experience and skills – we believe the top talent deserves the top dollar
• Bonus Potential (based on role and is discretionary) – if you go above and beyond, you should be rewarded
• 401k plans– we want to empower you to prepare for your future
• Room for growth and advancement- we love our employees and want to develop within

Good Health

• Comprehensive Medical, Dental, and Vision insurance plans
• Tax-free Dependent Care Account
• Life insurance, short-term, and long-term disability

Happiness

• Excellent PTO policy (everyone deserves a vacation now and then)
• Great work-life balance environment- We believe family comes first!
• Strong supportive teams- There is always a helping hand when you need it

The salary for a position is typically determined by multiple factors such as the individual's qualifications, experience, skills, and location. The projected compensation range for the position may vary based on these factors and could range from $80,000 to $100,000 (annualized USD). However, this estimate represents just one aspect of our total compensation package offered.