Risk Adjustment Compliance Project Manager

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We’re a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It’s our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

The Risk Adjustment Compliance Project Manager is responsible for leading compliance focused initiatives that ensure the accuracy, integrity, and regulatory adherence of Medica’s Risk Adjustment programs across Medicare Advantage, Medicaid, and ACA lines of business. This role provides subject matter expertise in regulatory requirements, audit readiness, and governance, and serves as a cross functional project leader for compliance, audit, and documentation initiatives.

The Risk Adjustment Compliance Project Manager plays a critical role in maintaining audit readiness, mitigating compliance risk, and ensuring risk adjustment policies, procedures, and provider education aligning with CMS and state regulations.

• Coordinate and support internal and external audits, including RADV and other regulatory or operational reviews
• Serve as the primary point of coordination for audit requests, documentation retrieval, validation, and submission
• Track audit findings and collaborate with stakeholders on corrective action plans and remediation efforts
• Support ongoing audit readiness by strengthening controls, workflows, and documentation standards

• Develop, maintain, and update Risk Adjustment policies, procedures, and standard operating documentation
• Ensure documentation reflects current regulatory guidance, operational practice, and internal control requirements
• Partner with Compliance and Operational leaders to ensure consistent application and understanding of policies
• Maintain auditready documentation, including version control and governance standards

• Lead Risk Adjustment compliance initiatives to ensure adherence to CMS and state regulatory requirements
• Interpret and operationalize regulatory guidance impacting risk adjustment documentation, submission, and oversight
• Partner closely with Compliance, Quality, Legal, and Risk Adjustment Operations to align compliance activities with enterprise standards
• Identify compliance risks, gaps, and trends, and drive mitigation strategies to reduce regulatory exposure

• Collaborate with Provider Engagement and Quality teams to support provider education related to compliant documentation and risk adjustment standards
• Ensure provider education materials align with regulatory requirements and Medica compliance expectations
• Act as a subject matter expert for documentation and compliance-related questions impacting providers and internal teams

• Lead compliance-driven risk adjustment projects from planning through execution
• Coordinate cross functional efforts to implement regulatory changes or compliance improvements
• Identify and implement process improvements that strengthen program integrity and operational effectiveness
• Provide compliance status updates and reporting to leadership as needed

• Bachelor’s degree in Healthcare Administration, Business, Health Information Management, Compliance, or related field
• 5+ years of experience in healthcare operations, risk adjustment, healthcare compliance and/or audit, or regulatory support

• Experience supporting RADV or CMS or DHS compliance audits
• Background in provider education, clinical documentation, or coding compliance
• Experience developing and maintaining healthcare policies and procedures
• Experience supporting…