Director, Product Manager, Risk Adjustment

Matrix Medical Network is the nation’s leading independent provider of comprehensive in-home health assessments. The Director, Product Manager - Risk Adjustment will lead product strategy for the technology that powers the Risk Adjustment ecosystem, focusing on creating complete member health pictures and improving clinician documentation and compliance.

Responsibilities:

• Defining and executing the product roadmap across prospective and retrospective risk adjustment workflows
• Building scalable capabilities supporting Medicare Advantage (CMS-HCC), ACA Marketplace (HHS-HCC), and Medicaid risk adjustment models
• Driving enhancements inside careflow™ that improve clinician experience and documentation quality
• Partnering with Clinical, Coding Operations, Engineering, Compliance, Finance, Customer Success and Executive Leadership
• Translating evolving CMS regulations, including V28, RADV and Medicaid model changes, into product strategy before the market catches up
• Leading build vs. buy decisions around AI-assisted coding, NLP, longitudinal patient records, audit analytics and risk prediction platforms
• Expanding interoperability through APIs, HIE integrations and FHIR-enabled data exchange
• Defining the analytics and reporting that demonstrate measurable client value
• Representing Product with customers and helping shape the future roadmap through real-world feedback

Requirements:

• 5+ years of Product Management experience
• 2+ years working within healthcare payer, value-based care or Risk Adjustment
• Deep understanding of HCC coding and CMS Risk Adjustment models across Medicare Advantage, ACA and Medicaid
• Experience translating CMS regulatory changes into product strategy
• Strong analytical skills with experience interpreting RAF performance, coding gaps, recapture metrics, encounter data and operational KPIs
• Familiarity with APIs, HIEs, FHIR and healthcare interoperability
• Demonstrated success leading highly cross-functional teams without direct authority
• Confidence representing product strategy with customers and executive stakeholders
• AI or NLP-assisted coding platforms (Optum, Apixio, Episource, Veradigm, etc.)
• Clinical Documentation Improvement (CDI)
• Provider query workflows
• HEDIS or Star
• Value-Based Care organizations
• Longitudinal patient data platforms
• In-home clinical services