Director, Risk Adjustment

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

📋 Description

• Create and implement the enterprise risk adjustment strategy and governance framework across all relevant lines of business.

• Track regulatory updates and new risk adjustment methodologies, adapting them into operational strategies and process enhancements.

• Supervise the accurate capture of diagnoses, retrieval of medical records, chart reviews, coding, validation, and submission of risk adjustment data.

• Establish and uphold coding standards, policies, procedures, and quality requirements.

• Manage coding quality assurance, second-level reviews, audits, corrective action processes, coder productivity, KPIs, and compliance.

• Develop and implement risk adjustment value-based programs in collaboration with key providers.

• Create and maintain an enterprise risk adjustment performance dashboard.

• Collaborate with actuarial and finance teams to assess the operational impact on risk scores and enhance projection accuracy.

• Provide executive leadership with consistent updates on performance, risks, opportunities, and suggested actions.

• Ensure preparedness for CMS RADV audits and regulatory reviews.

• Supervise external vendors that assist with chart retrieval, coding, analytics, and other risk adjustment activities.

• Lead, develop, and mentor teams and leaders in risk adjustment.

⛳️ Requirements

• Bachelor's degree in healthcare administration, business, health information management, nursing, public health, finance, or a related field.

• Eight (8) years of progressively responsible experience in healthcare risk adjustment, health plan operations, coding, clinical documentation, or a related area.

• Five (5) years of experience in a leadership role.

• Exceptional communication, analytical, organizational, and executive leadership abilities.

• Capability to manage multiple complex initiatives in a highly regulated and rapidly evolving environment.

• Work location/status within the United States of America as specified.

🏝️ Benefits

• Comprehensive health insurance plans.

• Retirement savings options with employer contributions.

• Opportunities for professional development and career advancement.

• Flexible working arrangements and work-life balance initiatives.