Talent.com
serp_jobs.error_messages.no_longer_accepting
Head of Risk Adjustment (New York)

Head of Risk Adjustment (New York)

Antidote HealthNew York, NY, US
job_description.job_card.variable_days_ago
serp_jobs.job_preview.job_type
  • serp_jobs.job_card.part_time
job_description.job_card.job_description

Company and Role Description

Antidote Healths mission is to redefine healthcare by providing affordable, high-quality, and accessible care and insurance products. As the Head of Risk Adjustment, you will lead our risk adjustment strategy, operations, and analytics to ensure compliance, accuracy, and financial sustainability. You will collaborate with cross-functional partners in Clinical, Provider Network, Product, Finance, Compliance, and Data Science to design and execute a best-in-class program that ensures complete and accurate risk capture, supports value-based care, and enables equitable outcomes for our members.

Key Responsibilities

Strategic Leadership & Program Management

  • Define and execute Antidotes risk adjustment strategy on the ACA Marketplace.
  • Lead and manage the Risk Adjustment process with finance, product, clinical, marketing, and operations, fostering a culture of accountability, innovation, collaboration, and continuous improvement.
  • Develop and oversee programs to maximize risk score accuracy, including chart reviews, suspecting, and gap closure initiatives.

Risk Adjustment Operations & Analytics

  • Partner with internal teams and external partners to forecast revenue, identify coding opportunities, and measure program performance.
  • Oversee end-to-end risk adjustment workflows across prospective and retrospective processes, including vendor management.
  • Develop dashboards, KPIs, and reports for executives to track performance and compliance.

    • Compliance & Quality Assurance

  • Ensure adherence to CMS, HHS, state-specific risk adjustment guidelines and monitor regulatory changes and proactively update processes.
  • Oversee processes for accurate and timely submissions (e.g., EDGE server submission).
  • Collaborate with Compliance and Legal to prepare for RADV audits, respond to regulatory inquiries, and mitigate compliance risks.

    • Cross-Functional Collaboration

  • Work closely with other teams to ensure accurate coding and data alignment.
  • Partner with Product and Engineering to design and enhance risk adjustment technology, including NLP / AI-enabled coding and chart retrieval solutions.
  • Engage with Finance leaders to forecast and reconcile risk-adjusted revenue.

    • Qualifications & Skills

    Required :

  • Bachelors degree in Analytics, Public Health, Business, or a related field (Masters preferred).
  • 7+ years of experience in leading risk adjustment processes. .
  • Demonstrated expertise in CMS-HCC, RxHCC, and HHS-HCC risk adjustment models.
  • Experience managing prospective and retrospective risk adjustment programs.
  • Strong data analytical skills
  • Knowledge of regulatory requirements (CMS, HHS, NCQA, ACA).
  • Excellent leadership, communication, and stakeholder management skills.
  • Prior leadership experience within Medicare Advantage, Medicaid Managed Care, or ACA health plans.

    • Preferred :

  • Experience with EDS submissions, EDGE server data validation, and encounter data management.
  • Familiarity with medical coding (ICD-10-CM, CPT, HCPCS) and clinical documentation improvement (CDI).
  • Ability to leverage technology (AI, NLP, machine learning) to improve risk adjustment performance.
  • Certified Risk Adjustment Coder (CRC), Certified Professional Coder (CPC), or similar credential preferred
    • serp_jobs.job_alerts.create_a_job

    Risk Risk York • New York, NY, US

    Job_description.internal_linking.related_jobs
    • serp_jobs.job_card.promoted
    Internal Audit & Risk Advisory Senior

    Internal Audit & Risk Advisory Senior

    EisnerAmperNew York, NY, United States
    serp_jobs.job_card.full_time
    At EisnerAmper, we look for individuals who welcome.Internal Audit & Risk Consulting Senior that will perform tasks that focus on full-cycle internal audit engagements, including overseeing and con...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Head of Firm Wide Risk

    Head of Firm Wide Risk

    FalconXNew York, NY, US
    serp_jobs.job_card.full_time
    FalconX is a pioneering team of operators, investors, and builders committed to revolutionizing institutional access to the crypto markets. Operating at the intersection of traditional finance and c...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day
    • serp_jobs.job_card.promoted
    Senior Consultant, Healthcare Risk Management & Advisory | Forensics and Litigation Consulting

    Senior Consultant, Healthcare Risk Management & Advisory | Forensics and Litigation Consulting

    FTI ConsultingNew York, NY, US
    serp_jobs.job_card.full_time
    Forensic & Litigation Consulting.FTI Consulting is the leading global expert firm for organizations facing crisis and transformation. We work with many of the world's top multinational corporations,...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Credit Risk (Risk Management) : Job Level - Vice President

    Credit Risk (Risk Management) : Job Level - Vice President

    Morgan StanleyNew York, NY, US
    serp_jobs.job_card.full_time
    The role will reside within the Firm Risk Management's Credit Risk Management department, which is a team dedicated to managing credit risk associated with Morgan Stanley's leveraged finance origin...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Associate Attorney

    Associate Attorney

    JobotTinton Falls, NJ, US
    serp_jobs.job_card.full_time
    Associate Attorney : General Liability Defense, Growing Firm, Excellent Benefits, Bonus, 401K!.This Jobot Job is hosted by : Patrick Murphy. Are you a fit? Easy Apply now by clicking the "Apply N...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    FS & SOX Internal Audit & Risk Advisory Manager

    FS & SOX Internal Audit & Risk Advisory Manager

    EisnerAmperNew York, NY, United States
    serp_jobs.job_card.full_time
    Internal Audit Consulting Manager.Risk & Compliance Services practice for our Financial Services clients.Focusing on Internal Audit, Internal Controls and Regulatory Compliance, we are seeking some...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Head of Risk Adjustment

    Head of Risk Adjustment

    Antidote HealthNew York, NY, US
    serp_jobs.job_card.full_time
    Antidote Health's mission is to redefine healthcare by providing affordable, high-quality, and accessible care and insurance products. As the Head of Risk Adjustment, you will lead our risk adjustme...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day
    • serp_jobs.job_card.promoted
    Director of Risk & Portfolio Advisory US Fundamental EquityNew York, New York, United States

    Director of Risk & Portfolio Advisory US Fundamental EquityNew York, New York, United States

    SchonfeldNew York, NY, US
    serp_jobs.job_card.full_time
    Director Of Risk & Portfolio Advisory US Fundamental Equity.We are seeking an exceptionally talented individual to join our Risk Management team as a Senior Risk Manager for our North American fun...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Internal Audit Director - Risk Management (Capital Planning)

    Internal Audit Director - Risk Management (Capital Planning)

    Morgan StanleyNew York, NY, US
    serp_jobs.job_card.full_time
    Director, Risk Management Capital Planning Audit.We're seeking someone to join our team as a Director on the Risk Management Capital Planning audit team to lead assurance activities related to firm...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Head of Technology Risk Management - Business Unit Risk Manager, Director

    Head of Technology Risk Management - Business Unit Risk Manager, Director

    MUFGJersey City, NJ, US
    serp_jobs.job_card.full_time
    Do you want your voice heard and your actions to count?.Discover your opportunity with Mitsubishi UFJ Financial Group (MUFG), one of the world's leading financial groups. Across the globe, we're 120...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    Associate Director, Risk Management | Hudson Tunnel Project

    Associate Director, Risk Management | Hudson Tunnel Project

    Platinum Global Talent Solutions Ltd.New York, New York, United States
    serp_jobs.job_card.full_time
    serp_jobs.filters_job_card.quick_apply
    About the Company & Project.Our client is a leading global Consultancy renowned for delivering high-profile, complex, iconic, large-scale capital projects. We are currently seeking a dedicated a...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Risk Manager - Engineering Advisory - Chief Risk Office

    Risk Manager - Engineering Advisory - Chief Risk Office

    BloombergNew York, NY, US
    serp_jobs.job_card.full_time
    Risk Manager - Engineering Advisory - Chief Risk Office.The energy of a newsroom, the pace of a trading floor, the buzz of a recent tech breakthrough. we work hard, and we work fast - while keeping...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Manager, Assurance & Risk Advisory (hybrid)

    Manager, Assurance & Risk Advisory (hybrid)

    StrykerMahwah, NJ, US
    serp_jobs.job_card.full_time
    Our team is growing, and we are seeking someone with internal audit expertise and risk acumen.Are you interested in driving improvements in risk management, controls, and governance processes? As a...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Manager, Compliance

    Manager, Compliance

    Novartis Group CompaniesEast Hanover, NJ, United States
    serp_jobs.job_card.full_time
    Join Novartis's dynamic Managed Markets Finance (MMF) Compliance team as a Manager, where you'll play a key role in embedding financial and IT controls across MMF operations.You'll help drive compl...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Head of Counterparty Credit Risk, Director

    Head of Counterparty Credit Risk, Director

    MUFGNew York, NY, US
    serp_jobs.job_card.full_time
    Do you want your voice heard and your actions to count? Discover your opportunity with Mitsubishi UFJ Financial Group (MUFG), one of the world's leading financial groups. Across the globe, we're 120...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Internal Auditor Risk Management Model Risk,

    Internal Auditor Risk Management Model Risk,

    Mizuho BankNew York, NY, US
    serp_jobs.job_card.full_time
    The Internal Audit Department Americas (IADA) provides internal audit services to the branches, representative offices and agencies of Mizuho Bank, Ltd. Americas, and to Mizuho Bank (USA) and relate...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Executive Director, Credit Risk-Hedge Funds & Asset Managers - New York

    Executive Director, Credit Risk-Hedge Funds & Asset Managers - New York

    Santander Holdings USA IncNew York, NY, United States
    serp_jobs.job_card.full_time
    Executive Director, Credit Risk-Hedge Funds & Asset Managers - New York.Country : United States of America.Santander is a global leader and innovator in the financial services industry.We believe th...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Risk Head Investor Services Digital Assets (MD)

    Risk Head Investor Services Digital Assets (MD)

    CitigroupNew York, NY, US
    serp_jobs.job_card.full_time
    Risk Head Investor Services Digital Assets (MD).Working at Citi is far more than just a job.A career with us means joining a team of more than 230,000 dedicated people from around the globe.At Citi...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Director, Healthcare Risk Management & Advisory | Forensics and Litigation Consulting

    Director, Healthcare Risk Management & Advisory | Forensics and Litigation Consulting

    FTI ConsultingNew York, NY, US
    serp_jobs.job_card.full_time
    Forensic & Litigation Consulting.FTI Consulting is the leading global expert firm for organizations facing crisis and transformation. We work with many of the world's top multinational corporations,...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Manager - Risk Advisory (Technology Risk) (NY)

    Manager - Risk Advisory (Technology Risk) (NY)

    CrossCountry ConsultingNew York, NY, US
    serp_jobs.job_card.full_time
    Manager - Risk Advisory (Technology Risk) (NY).From the beginning, our goal was to establish an advisory firm that stands apart from the rest one that is grounded in our Core Values and dedicated ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days