Risk Adjustment Compliance Project Manager

Audits & Readiness

Coordinate and support internal and external audits, including RADV and other regulatory or operational reviews.
Support ongoing audit readiness by strengthening controls, workflows, and documentation standards.

Policies & Procedures

Develop, maintain, and update Risk Adjustment policies, procedures, and standard operating documentation.
Ensure documentation reflects current regulatory guidance, operational practice, and internal control requirements.
Partner with Compliance and Operational leaders to ensure consistent application and understanding of policies.

Risk Adjustment Compliance & Governance

Lead Risk Adjustment compliance initiatives to ensure adherence to CMS and state regulatory requirements.
Interpret and operationalize regulatory guidance impacting risk adjustment documentation, submission, and oversight.
Partner closely with Compliance, Quality, Legal, and Risk Adjustment Operations to align compliance activities with enterprise standards.
Identify compliance risks, gaps, and trends, and drive mitigation strategies to reduce regulatory exposure.

Provider Education & Documentation Integrity

Collaborate with Provider Engagement and Quality teams to support provider education related to compliant documentation and risk adjustment standards.
Ensure provider education materials align with regulatory requirements and Medica compliance expectations.
Act as a subject matter expert for documentation and compliance-related questions impacting providers and internal teams.

Project Management & Continuous Improvement

Lead compliance-focused risk adjustment projects from planning through execution.
Cross-functional efforts to implement regulatory changes or compliance improvements.
Identify and implement process improvements that strengthen program integrity and operational effectiveness.
Provide compliance status updates and reporting to leadership as needed.

Qualifications

• Bachelor’s degree in Healthcare Administration, Business, Health Information Management, Compliance, or related field
• 5+ years of experience in healthcare operations, risk adjustment, healthcare compliance and/or audit, or regulatory support

Preferred Qualifications

• Experience supporting RADV or CMS or DHS compliance audits
• Background in provider education, clinical documentation, or coding compliance
• Experience developing and maintaining healthcare policies and procedures
• Experience supporting Medicare Advantage, Medicaid, or ACA risk adjustment programs

Skills

• Demonstrated experience supporting regulatory and operational audits, with a strong understanding of Risk Adjustment programs and applicable CMS and state regulatory requirements
• Proven ability to lead compliance-focused initiatives through effective project management, organization, and analytical skills
• Excellent written and verbal communication skills, with the ability to collaborate across cross-functional teams and communicate complex regulatory requirements clearly to both technical and non-technical stakeholders

Work Location

The position is an Office role, requiring an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN or Madison, WI.

Compensation & Benefits

The full salary grade for this position is $70,200 - $120,400. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $70,200 - $105,315. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data.

Equal Opportunity Employer

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.