Note: The job is a remote job and is open to candidates in USA. Alpine Physician Partners is a healthcare organization focused on risk adjustment and Star Ratings performance. The Program Manager, Risk Adjustment & Stars, connects technical teams with operational and business stakeholders, manages annual improvement programs, coordinates analytics and reporting, and supports compliance and audit readiness.
Responsibilities
- Owns the annual risk adjustment and Stars improvement program cycle, coordinating between technical teams and operational/business stakeholders across prospective and retrospective programs, visit-based campaigns, and gap closure workflows
- Builds and manages program timelines and throughput; reports progress to Alpine leadership and health plan partners in clear, business-friendly terms
- Leads cross-functional workgroups spanning coding/HCC teams, clinical quality, IT, and analytics, ensuring technical work stays aligned to operational priorities
- Manages program-level documentation and requirements, translating between technical specifications and operational plans
- Acts as the liaison between coding/data teams and operational stakeholders on HCC capture workflows, chart review pipelines, and gap identification, ensuring both sides understand priorities and constraints
- Manages relationships with vendors, coordinating technical file exchange and integration needs with operational timelines and expectations
- Monitors RAF score trends and performance results, working with analytics teams to interpret findings and translates them into operational action plans
- Coordinates risk adjustment data submission accuracy and reconciliation (EDS), connecting technical issue resolution with business and health plan deadlines
- Tracks HCC model version transitions (e.g., CMS-HCC V24/V28) and communicates their operational and financial impact to leadership and business teams
- Coordinates Alpine's Star Ratings strategy across HEDIS, CAHPS, HOS, and medication adherence measures, connecting technical measure logic with operational execution
- Partners with analytics teams to maintain measure-level performance tracking and cut-point modeling, translating results into operational priorities and gap closure plans
- Serves as one point of contact for Alpine with health plan Stars/quality teams, bridging technical data exchange requirements with operational and contractual needs
- Partners with analytics and data teams to define KPIs and dashboards for RAF accuracy, coding gap closure rates, and Star measure performance, ensuring outputs are operationally useful
- Translates CMS methodology updates (HCC model version changes, Star Ratings technical notes, measure weighting changes) for both technical teams (as specifications) and operational teams (as business impact)
- Helps identify and escalate data integrity issues across source systems (claims, EHR, supplemental data feeds), coordinating resolution between technical and operational owners
- Presents performance results and program recommendations to Alpine executive leadership and payer partners
- Ensures all program activities comply with CMS regulations, ICD-10-CM coding guidelines, and Alpine's compliance policies
- Supports RADV audit readiness and health plan data validation requests, coordinating between technical teams pulling data and operational/compliance teams managing the response
Skills
- Bachelor's degree in health informatics, data analytics, healthcare administration, business, or related field
- Five (5) to seven (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 effectively with both technical teams (data, analytics, IT) and operational/business stakeholders, translating between the two
- Proven program/project management experience managing cross-functional initiatives involving both technical and operational workstreams
- Working proficiency in Excel required
- Strong written and verbal communication skills, with the ability to translate technical and regulatory detail for operational and executive audiences
- Skilled at translating between technical and operational audiences, comfortable in both worlds without needing to be a deep technical expert
- Strong relationship management and cross-functional collaboration skills
- Analytical and detail-oriented, able to interpret data and technical findings and turn them into operational plans
- Adaptable to evolving CMS methodology and health plan requirements
- Able to travel to meetings
- Ability to handle multiple demands concurrently in a high stress environment; organize, coordinate, set priorities and meet deadlines
- Home office that is HIPAA compliant for all remote or telecommuting positions as outlined by the company policies and procedures
- Master's preferred
- Certified Risk Adjustment Coder (CRC) credential
- Experience with value-based care, ACOs, or delegated risk arrangements
- Familiarity with multiple health plan Stars/quality programs and data exchange requirements
- PMP or similar certification
- Familiarity with SQL, Tableau, Power BI, or similar tools a plus
Benefits
- Eligible for annual bonus based on individual and/or company performance.
- Includes medical, dental, and vision insurance; 401(k); paid time off (PTO); and Employee Assistance Program (EAP)
Company Overview