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Sr. Principal Risk Adjustment Solutions Partner



United States · Remote
Posted on Friday, April 19, 2024

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Sr. Principal Risk Adjustment Solutions Partner

Position Summary:

Owns assigned client relationships and acts as a subject matter expert and oversees the development and facilitation of the implementation of new and existing healthcare Quality & Risk Adjustment strategies at an advanced level. Guides and influences other departments and the client on quality and risk adjustment initiatives. Provides support for short- and long-term strategy, program planning and implementation, patient campaigns, outreach tactics, educational programs, data collection efforts, and develops and monitors key performance measurement activities.

Job Description:

Primary Responsibilities

  • Owns and manages a comprehensive Quality and/or Risk Adjustment strategy for our clients by developing data mining strategies and productive initiatives, implementing collection methodology and an effective quality & risk adjustment program ensuring successful completion of internal/external data validations, and developing and implementing of training program for internal and external clients.
  • Develops and fosters effective internal and external strategic relationships through effective and timely communication.
  • Synthesizes and organizes data, presents information, and provides executive summary of material.
  • Maintains accountability for outstanding customer service to all external and internal customers including timely responses.
  • Develops and maintains an expert level of knowledge of Medicare and risk-based reimbursement methodologies across Medicare Advantage, ACO REACH and other CMS programs.
  • Maintains professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks, and participating in professional societies.
  • Serves as a mentor to junior level associates and supports additional accounts as needed.
  • Identifies and implements department processes improvements.
  • Facilitates the development of key performance indicators.
  • Presents performance results and findings regularly including improvement strategies, tactics, and proposed solutions.
  • Serves as a subject matter expert for internal and external clients and may represent the department.
  • Supports or guides activities of internal RADV monitoring programs and internal and external RADV audits.
  • Performs other duties as assigned.


  • Bachelor's degree in Health Administration, Business Administration or related field or equivalent
  • 10+ years of experience within Healthcare, Health plan, or Health System required, including payer, hospital, Medicaid/Medicare, provider environment or managed care or the knowledge, skills, and abilities to succeed in the role
  • Deep knowledge and subject-matter expertise of Risk Adjustment Payment methodologies and understanding of the CMS HCC, HHS, and Medicaid
  • 2+ years proven track record of advancing matrixed health systems in value-based care initiatives
  • Experience presenting complex information in a concise and clear manner to Executive Leadership
  • Excellent leadership skills with the proven ability to guide cross-functional project teams
  • Exceptional judgment
  • Strong aptitude for critical thinking and data skills with the proven ability to identify, develop, communicate, implement, and impact process improvements and strategic initiatives
  • Proven ability to create results, prioritize workload, and respond to changing demands/timelines in a dynamic environment
  • Proficiency in Microsoft Office Programs including Word, PowerPoint, Excel, and Outlook
  • Excellent interpersonal and communication skills with the ability to collaborate and work through all professional levels, internally and externally
  • High caliber analytical and quantitative problem-solving skills


  • Professional coding certification such as CPC, CRC or equivalent

Working Conditions

  • While performing the duties of this job, the employee works in normal office working conditions.


  • The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.


Lumeris is an EEO/AA employer M/F/V/D.

The hiring range for this position is:


Factors that may be used to determine your actual pay rate include your specific skills, experience, qualifications, location, and comparison to other employees already in this role. This role may also be eligible for incentive compensation. At Lumeris, we are committed to providing a total rewards package that supports your overall well-being. Our benefits include medical, vision, dental, well-being programs, 401(k) with company matching, life insurance, paid time off including paid leave, and so much more. Learn more by visiting our Careers Page.

Member Facing Position:

No- Not Member or Patient Facing Position


Remote, USA

Time Type:

Full time

Lumeris and its partners are committed to protecting our high-risk members & prospects when conducting business in-person. All personnel who interact with at-risk members or prospects are required to have completed, at a minimum, the initial series of an approved COVID-19 vaccine. If this role has been identified as member-facing, proof of vaccination will be required as a condition of employment.