Director, Provider Risk Adjustment

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

📋 Description

• Act as the main escalation point and strategic leader for designated clients.

• Supervise the successful onboarding of new clients, which includes resource allocation, onboarding processes, workflow mapping, and education on EMR/projects.

• Maintain responsibility for contracted deliverables, which encompass coding quality, project guidelines, data analysis and reporting, as well as production standards.

• Facilitate regular meetings and updates with clients while providing proactive solutions to issues.

• Oversee and mentor coding professionals in both domestic and international locations.

• Ensure adherence to organizational coding standards, policies, and procedures.

• Track productivity and quality metrics, implementing performance enhancement plans as necessary.

• Collaborate with QA, Compliance, IT, and other internal stakeholders to ensure smooth service delivery.

• Lead recurring meetings and reporting cycles that cover KPIs, risks, and mitigation strategies.

• Identify and apply best practices across teams.

• Assess workflows and suggest improvements for efficiency, accuracy, and scalability.

• Assist in the development and deployment of coding tools, technologies, and reporting dashboards.

• Work together on pricing strategies and forecasting for resource management and capacity planning.

⛳️ Requirements

• A Bachelor's degree in Health Information Management, Health Administration, Finance, or a related field is required; a Master's degree is preferred.

• Over 10 years of progressive experience in medical coding or value-based care operations.

• At least 5 years of experience in a leadership role.

• Demonstrated experience in payer-side operations and risk-based programs.

• Strong knowledge of HCC coding practices, coding quality, and regulatory standards.

• Proven ability to manage global teams and vendor relationships effectively.

• Exceptional organizational, analytical, and communication skills.

• Proficient in MS Office and data analysis/reporting tools.

• Preferred 5 to 7 years of experience in value-based care organizations that include risk adjustment programs.

• Solid understanding of payer contracting, reimbursement practices, and the structure of programmatic policies and procedures.

• Experience with telecommuting and electronic medical record systems is highly preferred.

• Capability to work with a variety of clients and projects.

• Ability to operate with minimal supervision.

• Skills to supervise and mentor staff to foster development and contribute to company success.

• Proficient in problem-solving, data collection, fact establishment, and deriving valid conclusions.

• Ability to interpret technical instructions and manage both abstract and concrete variables.

• Comprehensive knowledge of HCC coding documentation requirements to ensure complete and accurate coding.

• Skills related to data quality and integrity.

• Familiarity with word processing, spreadsheet, and database software.

• Proficiency in English for both verbal and written communication is required.

• RHIA, RHIT, or CCS certification is preferred.

• Experience in a global revenue cycle management organization is preferred.

• Knowledge of payer reimbursement models and audit functions is preferred.

• Strong project and change management skills are preferred.

🏝️ Benefits

• Competitive annual salary.

• Medical/Dental/Vision Insurance.

• Equipment provided.

• 401k matching program.

• FTO: Flex Unlimited Annual PTO.

• Paid Paternity & Maternity leave programs.

• 9 paid annual holidays.

• Life Insurance.

• Long-term disability.

• Short-term disability options.

• Tuition reimbursement.