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Program Manager, Risk Adjustment – Stars
Alpine Physician Partners. Own the annual risk adjustment and Stars improvement program cycle across prospective and retrospective programs, visit-based campaigns, and gap closure workflows .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Medicare Advantage risk adjustment and Star Ratings improvement, with strong program management capabilities and the ability to translate technical specifications into actionable operational plans. Proficient in data analysis and relationship management, ensuring compliance with CMS regulations and effective collaboration across cross-functional teams.
Highest-signal resume keywords
Medicare Advantage Risk AdjustmentStar Ratings ImprovementProgram ManagementData AnalysisCross-Functional Collaboration
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Risk Adjustment ModelsRAF Score MethodologyEDS Submission ProcessesICD-10-CM Coding GuidelinesData InterpretationProject ManagementExcel
Soft Skills
Strong Communication SkillsRelationship ManagementOrganizational SkillsAdaptability
Tools & Technologies
SQLTableauPower BI
Certifications & Qualifications
Bachelor's DegreeCRC CredentialPMP Certification
Industry Keywords
CMS RegulationsHEDISCAHPSHOSValue-Based Care
Tech Stack
Tools & technologiesPMPSQLTableau
About the role
Key responsibilities & impact- Own the annual risk adjustment and Stars improvement program cycle across prospective and retrospective programs, visit-based campaigns, and gap closure workflows
- Build and manage program timelines and throughput; report progress to Alpine leadership and health plan partners
- Lead cross-functional workgroups spanning coding/HCC, clinical quality, IT, and analytics
- Manage program documentation and requirements, translating technical specifications into operational plans
- Liaise between coding/data teams and operational stakeholders on HCC capture, chart review, and gap identification workflows
- Manage vendor relationships and coordinate technical file exchange and integration needs
- Monitor RAF score trends and performance results and translate findings into operational action plans
- Coordinate risk adjustment data submission accuracy and EDS reconciliation
- Track HCC model version transitions and communicate operational and financial impacts
- Coordinate Star Ratings strategy across HEDIS, CAHPS, HOS, and medication adherence measures
- Partner with analytics teams on performance tracking, cut-point modeling, KPIs, and dashboards
- Serve as a point of contact with health plan Stars/quality teams
- Identify and escalate data integrity issues across claims, EHR, and supplemental data feeds
- Present performance results and program recommendations to executive leadership and payer partners
- Ensure compliance with CMS regulations, ICD-10-CM coding guidelines, and company policies
- Support RADV audit readiness and health plan data validation requests
Requirements
What you’ll need- Bachelor's degree in health informatics, data analytics, healthcare administration, business, or related field required
- 5 to 7 years of experience in Medicare Advantage risk adjustment and/or Star Ratings/quality improvement
- Working knowledge of CMS HCC risk adjustment models, RAF score methodology, EDS submission processes, and Star Ratings measure specifications
- Demonstrated ability to work with technical teams and operational/business stakeholders, translating between the two
- Proven program/project management experience managing cross-functional technical and operational initiatives
- Working proficiency in Excel required
- Strong written and verbal communication skills
- Strong relationship management and cross-functional collaboration skills
- Ability to interpret data and technical findings and turn them into operational plans
- Ability to adapt to evolving CMS methodology and health plan requirements
- Ability to travel to meetings
- Ability to handle multiple demands concurrently in a high-stress environment, organize, coordinate, set priorities, and meet deadlines
- HIPAA-compliant home office for remote or telecommuting positions
- CRC credential, value-based care/ACO/delegated risk experience, familiarity with multiple health plan Stars/quality programs, PMP or similar certification, and SQL/Tableau/Power BI familiarity preferred or a plus
Benefits
Comp & perks- Eligible for annual bonus based on individual and/or company performance
- Medical insurance
- Dental insurance
- Vision insurance
- 401(k)
- Paid time off (PTO)
- Employee Assistance Program (EAP)
- HIPAA-compliant home office for remote or telecommuting positions