Job Description

Job Description:

The Director of Risk Adjustment is a key leader responsible for overseeing and optimizing the organization’s risk adjustment programs to ensure compliance, accuracy, and operational efficiency. This role requires strategic oversight of risk adjustment strategies in alignment with value-based care objectives, enabling the organization to achieve financial and clinical outcomes while improving patient care.

Roles and Responsibilities:

Operational Oversight:

• Lead a team of risk adjustment professionals, providing guidance, mentorship, and performance evaluation.
• Optimize workflows to enhance the accuracy of diagnostic coding and documentation practices.

Strategic Leadership:

• Develop and implement comprehensive risk adjustment strategies that support the organization's value-based care goals.
• Collaborate with senior leadership to align risk adjustment initiatives with broader organizational objectives.

Program Management:

• Oversee the design, execution, and continuous improvement of risk adjustment processes, including data capture, coding accuracy, and submission compliance.
• Monitor industry trends and regulatory changes, ensuring the organization remains compliant with CMS (Centers for Medicare & Medicaid Services) and other applicable standards.

Data Analysis and Reporting:

• Utilize data analytics tools to identify opportunities for improved risk scores and financial performance.
• Generate detailed reports for leadership, highlighting trends, opportunities, and key KPIs.

Stakeholder Engagement:

• Serve as a liaison between internal teams (e.g., clinical, compliance, finance) and external partners, such as payers and regulatory agencies.
• Educate and train physicians and staff on best practices for documentation and coding accuracy.

Qualifications:

• Bachelor’s degree in healthcare administration, business, or a related field (Master’s preferred).
• 5+ years of experience in risk adjustment, population health, or a similar role, with at least 3 years in a leadership capacity.
• In-depth knowledge of value-based healthcare, risk adjustment methodologies, and regulatory requirements (e.g., HCC coding, RAF scoring).
• Strong analytical, communication, and leadership skills.

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