Director of Risk Adjustment

Job Summary

Leading the enterprise risk adjustment strategy, the full-time Director of Risk Adjustment will provide strategic direction and operational oversight to ensure accurate and compliant capture of member risk data while collaborating with various business leaders in a remote environment.

Key responsibilities

• Develop and execute the enterprise risk adjustment strategy and governance framework across all applicable lines of business
• Monitor regulatory changes and emerging risk adjustment methodologies, translating them into operational strategies and process improvements
• Oversee programs supporting accurate diagnosis capture, medical record retrieval, chart review, coding, validation, and submission of risk adjustment data

Required qualifications

• Bachelor's degree in healthcare administration, business, health information management, nursing, public health, finance, or a related field
• Eight years of progressive experience in healthcare risk adjustment, health plan operations, coding, clinical documentation, or a related discipline
• Five years of leadership experience