Senior Manager, Corporate Compliance - Risk Adjustment

Key Responsibilities

• Lead the Medicare Advantage Risk Adjustment compliance program.
• Monitor and interpret CMS regulations, HPMS memoranda, Final Rules, Medicare Managed Care Manual guidance, RADV requirements, and OIG enforcement activities.
• Assess operational processes for compliance risks related to risk adjustment activities.
• Develop and implement corrective action plans for identified compliance issues.
• Conduct compliance risk assessments related to coding, documentation, and encounter data submissions.

Required Qualifications

• Minimum 7 years of experience in Medicare Advantage, Risk Adjustment, Coding Compliance, Audit, or Regulatory Compliance.
• Minimum 5 years in a leadership role.
• One or more of the following certifications: CPMA (Certified Professional Medical Auditor), CRC (Certified Risk Adjustment Coder), CPC (Certified Professional Coder), CCS (Certified Coding Specialist).
• Willingness to travel up to 10% (including by plane).

Preferred Qualifications

• Health Information Management (RHIA/RHIT).
• Nursing – Strong understanding of clinical documentation and medical record review.
• Certified Risk Adjustment Coder (CRC) with compliance experience.
• Provider coding audit/compliance leadership experience.
• Medicare Advantage compliance leadership experience supporting RADV, HCC validation, and CMS audits.

Education

• Bachelor's degree in Health Information Management, Healthcare Administration, Nursing, Public Health, Business Administration, Healthcare Compliance, or a related healthcare field required; equivalent years of work experience may substitute.