Manager, Burden of Illness Operations (RBE)

Job Description Summary

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The Manager of Burden of Illness (BOI) reports to the Director of Burden of Illness. The Manager is responsible for the day-to-day management and execution of the organization's Burden of Illness and Risk Adjustment initiatives. This role oversees operational workflows, leads the BOI team, monitors performance metrics, and collaborates with internal departments and external partners to improve coding accuracy, documentation quality, and risk adjustment performance. The Manager supports organizational value-based care initiatives by ensuring operational excellence, regulatory compliance, and continuous process improvement.

Essential Duties and Responsibilities

• Manage daily BOI and Risk Adjustment operations to ensure timely and accurate execution of departmental goals.
• Supervise, mentor, and develop BOI team members while fostering a culture of accountability, collaboration, and continuous improvement.
• Monitor key performance indicators (KPIs), coding trends, provider performance, RAF accuracy, and documentation quality.
• Analyze operational and financial data to identify opportunities for workflow improvements and increased coding capture.
• Ensure compliance with CMS, Medicare Advantage, ACO, and other regulatory coding and documentation requirements.
• Collaborate with Clinical Operations, Provider Relations, Quality, Finance, IT, Analytics, and Population Health teams to support organizational objectives.
• Partner with vendors and health plan representatives to support operational performance and contractual deliverables.
• Oversee reporting related to code validation, provider performance, prevalence rates, RAF trends, acceptance/rejection rates, and quality metrics.
• Identify opportunities to improve technology, reporting, automation, and operational efficiency.
• Develop and implement standardized workflows, policies, and best practices.
• Support provider education initiatives focused on documentation improvement and coding accuracy.
• Monitor coding quality through audits and provide feedback to coding staff and leadership.
• Prepare and present operational reports and recommendations to department leadership.
• Participate in strategic initiatives and special projects supporting value-based care and population health programs.
• Assist leadership with annual operational planning, staffing, budgeting, and resource allocation.

• Maintain effective communication with internal stakeholders and external partners.

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How will you make an impact & Requirements

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The Manager of Burden of Illness (BOI) reports to the Director of Burden of Illness. The Manager is responsible for the day-to-day management and execution of the organization's Burden of Illness and Risk Adjustment initiatives. This role oversees operational workflows, leads the BOI team, monitors performance metrics, and collaborates with internal departments and external partners to improve coding accuracy, documentation quality, and risk adjustment performance. The Manager supports organizational value-based care initiatives by ensuring operational excellence, regulatory compliance, and continuous process improvement.

Essential Duties and Responsibilities

• Manage daily BOI and Risk Adjustment operations to ensure timely and accurate execution of departmental goals.
• Supervise, mentor, and develop BOI team members while fostering a culture of accountability, collaboration, and continuous improvement.
• Monitor key performance indicators (KPIs), coding trends, provider performance, RAF accuracy, and documentation quality.
• Analyze operational and financial data to identify opportunities for workflow improvements and increased coding capture.
• Ensure compliance with CMS, Medicare Advantage, ACO, and other regulatory coding and documentation requirements.
• Collaborate with Clinical Operations, Provider Relations, Quality, Finance, IT, Analytics, and Population Health teams to support organizational objectives.
• Partner with vendors and health plan representatives to support operational performance and contractual deliverables.
• Oversee reporting related to code validation, provider performance, prevalence rates, RAF trends, acceptance/rejection rates, and quality metrics.
• Identify opportunities to improve technology, reporting, automation, and operational efficiency.
• Develop and implement standardized workflows, policies, and best practices.
• Support provider education initiatives focused on documentation improvement and coding accuracy.
• Monitor coding quality through audits and provide feedback to coding staff and leadership.
• Prepare and present operational reports and recommendations to department leadership.
• Participate in strategic initiatives and special projects supporting value-based care and population health programs.
• Assist leadership with annual operational planning, staffing, budgeting, and resource allocation.
• Maintain effective communication with internal stakeholders and external partners.

Education and Experience

• Bachelor's degree in Healthcare Administration, Business Administration, Public Health, or related field or equivalent years of experience.

Minimum 5 years of Medicare Risk Adjustment experience.

• Minimum 2-3 years of leadership or supervisory experience.
• Experience with Medicare Advantage, MSSP ACOs, and value-based care programs preferred.
• Strong knowledge of CMS-HCC Risk Adjustment methodology.

Required Skills and Abilities

• Strong leadership and team development skills.
• Excellent analytical and problem-solving abilities.
• Knowledge of Risk Adjustment operations and coding compliance.
• Strong communication and presentation skills.
• Ability to prioritize multiple projects in a fast-paced environment.
• Experience leading operational improvement initiatives.
• Strong collaboration and relationship-building skills.
• Ability to communicate complex data into actionable recommendations.
• High attention to detail and organizational skills.
• Proficiency with Microsoft Office and reporting tools.

Managerial Responsibilities

• Directly supervise BOI team members and coding staff.
• Conduct hiring, onboarding, coaching, performance evaluations, and corrective action when appropriate.
• Establish team goals aligned with departmental objectives.
• Monitor productivity, quality metrics, and staff development.
• Promote employee engagement and professional growth.
• Foster collaboration across departments.

Key Performance Measures

• BOI capture rate improvement
• RAF accuracy
• Coding quality scores
• Provider engagement and education completion
• Coding turnaround times
• Audit accuracy
• Vendor performance
• Department productivity
• Compliance with CMS and organizational standards
• Team engagement and retention

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Compensation Range:

$85,159.00

to

$127,738.00

The anticipated base salary range represents the Company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.