AVP, Medicare Risk Adjustment Performance

This is a fully remote position, open to applicants in United States.

📋 Description

• Provide leadership at the executive level for Alignment's enterprise Risk Adjustment performance strategy and operations.

• Guide the development and implementation of prospective, concurrent, and retrospective Risk Adjustment strategies.

• Drive execution by providers and the market to meet annual RAF performance goals.

• Oversee provider engagement, coding operations, chart retrieval, submission, analytics, vendor management, and revenue realization.

• Collaborate with Market Operations, Network Management, Clinical Operations, Finance, Compliance, and Data & Technology teams.

• Lead the creation of the annual operating plan, including objectives, metrics, milestones, resources, and market-level execution strategies.

• Set and monitor performance guidelines for quality, productivity, service levels, and financial results.

• Utilize analytics, reporting, and strategic business analysis to uncover opportunities, risks, root causes, and interventions.

• Collaborate with Finance and Actuarial teams on forecasting, revenue impacts, bid development, and long-term planning.

• Define strategic direction and performance expectations for Risk Adjustment vendors and external partners.

• Act as the executive sponsor for initiatives aimed at improving provider coding performance and documentation.

• Develop scalable reporting, analytical, and operational capabilities to enhance visibility, audit preparedness, and reduce manual controls.

• Work with DTS and enterprise analytics teams on data strategy and reporting frameworks.

• Define the requirements for modernizing workflows, automation, provider enablement, and enterprise reporting.

• Sponsor technology initiatives to boost scalability, productivity, transparency, and audit readiness.

• Support RADV readiness, validation outcomes, reconciliation, diagnosis corrections, and audit remediation efforts.

• Establish policies, procedures, standard work, and governance routines to ensure accurate and compliant execution.

• Stay informed about CMS requirements, model changes, and regulatory guidance, translating these changes into operational plans.

• Communicate intricate operational, technical, and financial information as executive insights and business narratives.

• Build, mentor, and retain a high-performing multidisciplinary team.

• Develop multi-year strategies, annual objectives, KPIs, and resource needs.

• Lead business cases for investments, operational initiatives, and technological capabilities.

• Supervise assigned leaders and staff, including workforce planning, recruiting, training, goal-setting, performance management, and coaching.

• Carry out additional duties as assigned.

⛳️ Requirements

• A minimum of ten years of progressive experience in managed care, Medicare Advantage, healthcare analytics, healthcare finance, risk adjustment, population health, or related operations.

• Proven experience in leading enterprise Risk Adjustment programs across various markets and provider arrangements.

• Demonstrated responsibility for financial performance, forecasting, strategic planning, or significant business initiatives.

• Established track record in managing executive stakeholders and enterprise-wide programs.

• At least seven years of leadership experience, including the development of high-performing analytical or operational teams.

• Bachelor’s degree in healthcare, business, finance, analytics, information systems, or a related field, or equivalent relevant experience.

• Proven understanding of CMS-HCC risk adjustment methodology, Medicare Advantage reimbursement, coding and documentation programs, encounter data, and performance measurement.

• Demonstrated experience in designing or leading analytics, reporting, data governance, or scalable data infrastructure that supports reporting accuracy, regulatory compliance, and audit readiness.

• Experience in leading complex cross-functional initiatives and working with executives, providers, vendors, compliance partners, and technical teams.

• Familiarity with risk adjustment forecasting, provider performance analytics, data warehousing, SQL-based analytics, or business intelligence platforms.

• Experience supporting multiple government program lines of business or extensive, multi-market Medicare Advantage operations.

• Advanced capability to translate complex data into executive-level insights, recommendations, and action plans.

• Excellent verbal, written, presentation, organizational, and relationship-management skills.

• Proficiency in Excel is required; SQL knowledge is preferred.

• Strong organizational skills.

• Good analytical abilities.

• Strong interpersonal skills.

• Excellent communication skills.

🏝️ Benefits

• Comprehensive health insurance plans.

• Retirement savings options with company match.

• Professional development and continuing education support.

• Flexible work schedules.

• Generous paid time off and holiday policies.