Product Manager, Risk Adjustment Solutions

Vatica Health is seeking a Product Manager to lead Risk Adjustment product capabilities across various business lines, including Medicare Advantage, ACA Marketplace, and Medicaid. This role involves overseeing the execution and evolution of Risk Adjustment solutions, ensuring compliance and efficiency for health plans and provider organizations.

Responsibilities:

• Own development and management of core Risk Adjustment capabilities including:
• HCC model updates and configuration
• Risk score computation across supported models
• Suspect generation and accuracy management
• Encounter data reconciliation
• Risk adjustment reporting and analytics
• Ensure platform support for
• Medicare Advantage (CMS-HCC)
• ACA Marketplace (HHS-HCC)
• Medicaid risk adjustment models
• Track CMS announcements and regulatory updates
• Ensure timely platform updates aligned with HCC model changes
• Monitor LOB-specific submission timelines and program requirements
• Work closely with clinical coding teams and outbound operations teams to support operational readiness
• Identify and define new feature enhancements
• Design product workflows and requirements
• Maintain and prioritize product backlog
• Work with engineering teams and TPMs to track development progress
• Validate completed features prior to release
• Work closely with Customer Success teams to understand client workflows and challenges
• Participate in client discussions when needed
• Translate client feedback into product improvements and roadmap priorities
• Work in close collaboration with the Head of Platform to align Risk Adjustment capabilities with overall platform strategy
• Provide domain expertise and product insights to inform roadmap planning

Requirements:

• 5+ years Product Management experience
• 5+ years experience with Risk Adjustment or Population Health technology
• Strong understanding of Medicare Advantage, ACA, or Medicaid risk programs
• Familiarity with HCC models and coding workflows
• Experience collaborating with engineering teams on healthcare platforms