Senior Risk Adjustment Operations Associate

Job Description

A bit about this role: 

We are seeking a meticulous and technically skilled Operations Senior Associate to lead the intake and administrative phase of our risk adjustment external audit operational pipeline. This role is responsible for the front-end intake of retrieved medical documents, ensuring every document is accurately classified, appropriately split into unique encounters, and validated for eligibility before moving further into the evaluation process. This role supports audit operations and special projects. Audits include CMS Risk Adjustment Data Validation (RADV) audits and Part C Improper Payment Measurement audits. Special projects include implementing AI tools for automated data abstraction and document management. While your primary focus is on the early-stage audit pipeline, you will also serve as a key member of the External Audit Program team, supporting the end-to-end management of the entire audit lifecycle.

Your Responsibilities and Impact will include: 

• Manage the end-to-end administrative review process, including document triage, classification, and the technical execution of document management processes.

• Coordinate and direct day‑to‑day work activities of assigned team members for document‑related tasks, ensuring priorities, timelines, and quality standards are met; partner with Devoted’s internal management team to align assignments and resolve resource issues.

• Conduct detailed quality assurance checks to ensure accuracy of work output.

• Oversee and refine the use of AI-native tools for automated administrative information extraction to support the highest quality work of the team and process

• Serve as a bridge between teams, providing rapid feedback on success and document quality to inform strategic pivots in audit approach.

• Partner closely with internal technology teams to resolve system issues and optimize processes.

• Prepare and deliver metrics, error trends, and resolution summaries for audit operations reporting; leverage AI, SQL, Looker, or other BI tools to extract and analyze workstream data where appropriate.

• Document and update standard operating procedures (SOPs) to ensure operational consistency.

Required skills and experience: 

• Proven experience as an operator who takes initiative with a strong problem-solving mindset and the ability to adapt to changing situations and requirements.

• Strong attention to detail with the ability to perform meticulous QA under time‑sensitive conditions.

• High degree of comfort pulling and analyzing data using spreadsheets, with experience or appetite to leverage database query tools. 

• Ability to identify anomalies and troubleshoot technical errors and partner effectively with IT and technical teams.

• Strong organizational skills and experience managing high‑volume workflows with compressed timelines.

• Experience collaborating with offshore resources or distributed teams, with the ability to clearly communicate priorities and task requirements without direct managerial authority

• Excellent communication and collaboration skills for working with cross-functional teams. 

Desired skills and experience: 

• Bachelor’s degree in Healthcare Administration, Health Information Management (HIM), Business, or related field. Relevant professional experience will be considered in lieu of a bachelor's degree.

• Familiarity with healthcare data (e.g., ICD‑10-CM medical diagnosis codes)

• Experience transforming operations through AI-enabled workflows

Salary range: $58,000 - $83,000 / year

The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

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