UST · 2 weeks ago
Director, Risk Adjustment Products
United States
Full-time
Remote
Director/Executive
$170K/yr - $225K/yr
10+ years expUST HealthProof is a trusted partner for health plans, offering an integrated ecosystem for health plan operations. The Director, Risk Adjustment Products will lead the strategy, roadmap, and execution for the product portfolio focused on retrospective risk adjustment solutions, working closely with technical and operations teams to create innovative solutions that deliver measurable impact for customers.
ConsultingInformation ServicesInformation Technology
Responsibilities
Define multi-year plans aligned to customer outcomes, regulatory drivers, and market trends in risk adjustment, care management, and provider enablement
Identify and prioritize use cases that leverage AI/ML and real-time data signals to surface high-impact suspects and coding opportunities
Drive innovation leveraging interoperability standards (FHIR, HL7, APIs) to enable seamless enablement with EHRs, care management platforms, and third-party integrations
Balance innovation with compliance, audit defensibility, and clinical integrity across all product decisions
Lead the end-to-end product lifecycle, including ideation, requirements gathering, development, launch, and post-launch optimization
Work closely with Engineering and Data Science to build predictive models and real-time data pipelines that power suspecting and concurrent workflows
Ensure products are clinically relevant, user-centric, and integrated into existing payer and provider workflows through interoperability integrations
Set and track KPIs for each product line, such as suspect accuracy, provider engagement, risk score impact, and concurrent coding capture and correction rates
Establish and track KPIs that measure both risk adjustment performance and interoperability success (data exchange rates, provider adoption)
Serve as a trusted partner and clinical product expert for internal stakeholders (Sales, Clinical, Operations, Client Success) and external clients (health plans, ACOs, risk bearing provider groups)
Lead customer discovery and feedback sessions to deeply understand provider workflows, documentation behaviors, and concurrent coding needs
Present product strategy and roadmap updates to executive stakeholders and client advisory boards
Partner with Legal, Compliance, and Policy teams to interpret and operationalize updates from CMS (e.g., Final Rules, model updates, guidance on medical record standards)
Implement and monitor processes that ensure defensibility of all outputs, documentation standards, and audit trails
Design and embed audit readiness into product workflows, ensuring all activities are traceable, evidence-backed, and aligned with CMS documentation requirements
Provide strategic recommendations and decision frameworks when trade-offs between revenue, compliance, and user experience arise
Build, lead, and coach a team of Product Managers working across different facets within prospective and concurrent solutions
Provide mentorship, performance management, and career development aligned with leadership principles and growth culture
Establish best-in-class product practices and instill a culture of experimentation, feedback, and continuous learning
Support resourcing and hiring plans as product needs evolve and grow
Leads the product strategy, development and continuous refinement of the firm's risk adjustment product roadmap, ensuring it aligns with strategic goals and industry best practices
Leads and manages teams, often geographically dispersed, responsible for risk adjustment activities, ensuring high performance and employee engagement
Oversee the performance of automated processes, such as AI-driven chart reviews, and ensure operational excellence in risk adjustment operations
Serve as a subject matter advisor and primary point of contact for health clients, proactively identifying and communicating risks and improvement opportunities, and ensuring client satisfaction
Contribute to the development of long-range goals and objectives for risk adjustment programs, incorporating best practices and emerging trends
Work with various departments, including revenue management, coding, and compliance, to align activities and promote objectives
Build and maintain solid relationships with both internal and external stakeholders, including providers, vendors, and regulatory bodies
Qualification
Required
Bachelor's degree in business or technical field required
10+ years of Risk Adjustment product management experience required
5+ years leadership experience required
Experience with Risk Adjustment Products, developing and executing risk adjustment strategies, managing the retrieval and interoperability roadmap, improving retrieval yield, and supporting commercial client growth
Experience building the product strategy from scratch, creating the roadmap and executing with the Technology and Operation stakeholders
Understanding of risk adjustment methodologies, including HCCs, CRGs, and other risk adjustment models used by CMS and commercial health plans
Understanding of Medical Record Review, digital channels and interoperability and experience in chart retrieval products or operations
Understanding of SQL, Core Java, Spring Boot, Web Services, XML, JSON, SQL, Middleware, and CI/CD pipeline philosophy
Ability to maintain confidentiality
Thrives in a dynamic, sometimes ambiguous environment and has a knack for quickly prioritizing needs and creating scalable processes and structure
Comfortable in a fully remote environment that relies heavily on asynchronous written collaboration and communication
Preferred
Master's degree in business or technical field preferred
Experience with people management, mentorship and creating inclusive and diverse teams
Working in AWS cloud environment and experience with AWS cloud services
Awareness of Agile tools and methodologies
Benefits
Full-time, regular employees accrue up to 16 days of paid vacation per year
Receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year)
10 paid holidays
Eligible for paid bereavement leave
Eligible to participate in the Company’s 401(k) Retirement Plan with employer matching
Eligible for medical, dental, and vision insurance
Basic life insurance
Accidental death and disability insurance
Short- and long-term disability benefits
May purchase additional voluntary short-term disability benefits
Participate in a Health Savings Account (HSA)
Flexible Spending Account (FSA) for healthcare, dependent child care, and/or commuting expenses
Potential for quarterly incentive-based bonuses and or commissions depending on role
Company
UST
UST is a Digital Transformations Solutions Provider.
10001+ employees
H1B Sponsorship
UST 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 (870)
2024 (800)
2023 (647)
2022 (634)
2021 (612)
2020 (984)
Funding
Current Stage
Late StageTotal Funding
$250MKey Investors
Temasek Holdings
2018-06-27Private Equity· $250M
Leadership Team
Krishna Sudheendra
CEO
Alexander Varghese
Chief Administrative Officer & COO
Recent News
2026-01-20
2026-01-20
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