Alignment Health · 3 weeks ago
Technical Product Manager – Medicare Risk Adjustment Solutions
United States
Full-time
Remote
Mid, Senior Level
$113K/yr - $170K/yr
5+ years expAlignment Health is a company dedicated to transforming the lives of seniors and those who are chronically ill. The Technical Product Manager will be responsible for driving the strategy and delivery of Medicare's risk adjustment models, requiring a blend of clinical knowledge and technical skills to ensure compliance and improve outcomes for members.
Health CareHospitalMedicalMedical DeviceWellness
Responsibilities
Drive the functional and technical roadmap for risk adjustment systems, including provider engagement tools, data / document analytics platforms, and enterprise technology goals
Guiding the technical implementation of risk adjustment solutions, potentially working with data platforms, ETL processes, and vendor integrations
Anticipate regulatory and operational changes (e.g., CMS rule updates, encounter data submission requirements) and integrate them into the roadmap
Ensuring Alignment’s technical solutions address quality, accuracy, and completeness of data used for risk adjustment, often involving monitoring data submissions and addressing gaps
Collaborate with internal and external coding, analytics, and clinical teams to ensure accurate and complete diagnosis coding and HCC Gap Closures
Translate CMS regulations and Medicare operational requirements into actionable business and system requirements
Partner with vendors to manage technical solutions and integrations, ensuring compliance with service-level agreements (SLAs)
Collaborating with various stakeholders, including clinical teams, provider groups, IT departments, actuarial services, and regulatory bodies, to align strategies and drive program success
Assists with CMS Risk Adjustment Data Validation activities to ensure our external physicians and Alignment Healthcare is prepared for and will pass an audit
Qualification
Required
5+ years of Product Management or Business Analyst experience in healthcare payer systems, with at least 3 years focused on Medicare Advantage, ACA, HCC models, and related coding and documentation guidelines
Experience in healthcare operations, provider enablement, or working with health plans and risk adjustment vendors
Proven hands-on expertise with Microsoft SQL (querying, optimization, reconciliation, audits)
ETL Tools such as Microsoft SSIS and Azure Data Factory
Cloud Platforms (Azure/AWS)
Experience integrating vendor solutions
Solid understanding of what drives MRA accuracy and compliance in a Medicare environment
Strong analytical, problem-solving, and communication skills with the ability to translate technical details into business outcomes
Bachelor's degree in Information Systems, Computer Science, Business, Healthcare Administration, or related field. 4 years additional experience may be considered in lieu of education
Preferred
MBA or advanced degree preferred
Deep understanding of Medicare Advantage, ACA, HCC models, and related coding and documentation guidelines
Proficiency in relevant technical tools, such as SQL, Azure Data Factory, Jira, Confluence, or specific risk adjustment analytics platforms
Experience in defining product strategies, managing product backlogs, and working within agile development methodologies
Familiarity with EDI standards and file protocols (HIPAA 837/835/820, XML, PDF fulfillment)
Vendor management and SLA performance oversight
Company
Alignment Health
Alignment Health provides eldercare services.
501-1000 employees
H1B Sponsorship
Alignment Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (3)
2024 (12)
2023 (17)
2022 (13)
2021 (11)
2020 (6)
Funding
Current Stage
Public CompanyTotal Funding
$696.05MKey Investors
K2 HealthVenturesWarburg PincusGeneral Atlantic
2024-11-15Post Ipo Debt· $321.05M
2024-01-09Private Equity
2021-03-26IPO
Leadership Team
Dawn Maroney
President, Markets & CEO of Alignment Health Plan
John Kao
CEO and Founder
Recent News
Alignment Healthcare USA, LLC
2025-10-31
Alignment Healthcare USA, LLC
2025-10-14
Company data provided by crunchbase