SIHO Insurance Services · 2 months ago
Risk Adjustment Program Manager
Columbus, IN, USA
Full-time
Onsite
Senior Level
5+ years expSIHO Insurance Services is focused on providing effective risk adjustment solutions, and they are seeking a Risk Adjustment Program Manager to oversee all risk adjustment activities. This role will support Medicare Advantage and ACA risk adjustment programs while ensuring compliance with regulatory guidelines and improving risk adjustment outcomes.
Employee BenefitsFinancial ServicesHealth CareHealth InsuranceInsurance
Responsibilities
Serve as the expert on Medicare Risk Adjustment models; monitor regulatory changes, ensuring adherence to CMS/HHS guidelines
Develop and monitor metrics and KPIs to track the success of solutions and improvements; develop dashboards to share risk adjustment trends to key stakeholders; communicate risk adjustment impacts across all levels of the company
Conduct comprehensive research and analysis to identify trends and areas of opportunity related to risk adjustment; contribute to the development and implementation of strategic initiatives and a risk adjustment work plan; collaborate with plan partners to leverage a lean team and all possible resources to improve risk adjustment outcomes
Responsible for forecasting revenue and collaborating with finance team
Create and maintain department policies and procedures
Ensure plan readiness and compliance for RAD-V and CMS audits
Own vendor oversight of data integration and coding accuracy for Encounter Data Submissions and risk analytics
Qualification
Required
Minimum of 5 years of experience in Medicare risk adjustment
Strong knowledge of CMS risk adjustment models/methodologies and HCC coding
Strong analytical, organizational, problem-solving, vendor management, and critical thinking skills
Ability to work independently and manage multiple projects involving cross-functional teams and external vendors
Ability to interpret and analyze complex data and translate this into meaningful, actionable information
High standards of quality and accuracy
Advanced skills in Microsoft Excel
Commitment to maintaining confidentiality in compliance with HIPAA
Company
SIHO Insurance Services
SIHO Insurance Services is an insurance company that provides complete health benefit services to small, medium, and large employers.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
John Sadtler
President and Chief Executive Officer
Kramer Rick
CFO
Recent News
Inside INdiana Business
2025-10-06
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