Note: The job is a remote job and is open to candidates in USA. Matrix Medical Network is the nation’s leading independent provider of comprehensive in-home health assessments, and they are seeking a Director, Product Manager for Risk Adjustment. The role involves leading product strategy for their Risk Adjustment ecosystem, focusing on enhancing clinician documentation and ensuring compliance with regulatory changes.
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
Skills
- 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
Benefits
- Medical, dental, vision, paid time off, paid holidays, 401(k) with company matching, voluntary life insurance, short-term disability, long-term disability, employee assistance program, health savings account, flexible spending accounts, and additional voluntary benefits.
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