Mass General Brigham · 2 weeks ago
Director Medicare and Medicaid Risk Adjustment
United States
Full-time
Remote
Director/Executive
$144K/yr - $210K/yr
8+ years expMass General Brigham is a not-for-profit organization focused on patient care, research, teaching, and community service. The Director of Medicare and Medicaid Risk Adjustment will support programs through data management and submissions, including analysis, reporting, and collaboration with various business units.
Health CareHome Health CareMedical
Responsibilities
Perform analysis and reporting activities relating to: risk score calculation, claims/encounters data submission, chart review programs, audits, and related performance metrics
Participate in the development of requirements, testing and refinement of the underlying data and systems
Collaborate with other business units to deliver reports/updates on underlying data and systems as used by the Risk Adjustment team
Analyze data flow and data integrity to identify areas for improvement
Operate risk adjustment analytic vendor platforms to assist with intervention tracking, monitoring, analysis and reporting of diagnosis codes that drive risk score calculations
Work cross-functionally across multiple departments to design and develop financial dashboards, KPIs, and models to identify and track profit/loss and ROI trends
Qualification
Required
Bachelor's Degree required (experience can be considered in lieu of a degree)
8-10+ years of experience in risk adjustment programs required
Experience with predictive modeling software required
Subject Matter Expert on Medicare Advantage encounter data submissions
Advanced SQL and or SAS programming skills required
Understanding of healthcare claims coding practices required
Demonstrate Mass General Brigham Health Plan's core brand principles of always listening, challenging conventions, and providing value
Bring fresh ideas forward by listening to and working with employees and the people we serve
Respect the talent and unique contributions of every individual and treat all people in a fair and equitable manner
Strong, demonstrated track record of an ability to execute on time, on budget, and on scope
Strong aptitude for technology-based solutions
Ability to inject energy, when and where it's needed
Current in healthcare trends
Demonstrated forward, visionary thinking; ability to see 'what is' and envision 'what could be.'
Ability to develop, introduce, defend, and gain support for a new ideas and approaches
Excellent leadership skills and leadership track record
Ability to translate and communicate complex topics in a variety of forums, tailoring communications to effectively fit and influence the targeted audience, strong executive presence, presentation, and communication skills. Strong verbal, active listening, and written communication skills required
Ability to view the long-range trends and cycles of the business and industry and see the 'big picture.'
Ability to apply a variety of strategic frameworks to analyze problems and to guide and develop solutions
Ability to challenge the status quo and drive innovative thinking and the capability to successfully implement strategy
Excellent interpersonal skills, including the ability to influence others at all levels of an organization
Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback
Unquestionable integrity
Preferred
Master's degree preferred
Certified Risk Adjustment Coder (CRC) or the equivalent coding accreditation preferred
5+ years in a leadership role for Medicare Advantage and Medicaid risk adjustment is highly preferred
At least 5-7 years of experience managing others is preferred
Benefits
Comprehensive benefits
Career advancement opportunities
Differentials
Premiums and bonuses as applicable
Recognition programs designed to celebrate your contributions and support your professional growth
Company
Mass General Brigham
Mass General Brigham specializes in providing medical treatments and health diagnostics services.
10001+ employees
H1B Sponsorship
Mass General Brigham 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 (77)
2024 (61)
2023 (93)
2022 (70)
2021 (80)
2020 (29)
Funding
Current Stage
Late StageLeadership Team
E
Erin Flanigan
SVP, Human Resources, Community, Specialty Hospital Division
O’Neil A. Britton
Chief Integration Officer, Executive Vice President
Recent News
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2026-01-24
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