Director of Risk Adjustment Operations

Job Summary

Seeking a strategic leader, the full-time remote Director of Risk Adjustment Operations will manage the end-to-end operational success of data submissions and the Retrospective Chart Review Program, ensuring accurate risk adjustment data through effective metrics and vendor management.

Key responsibilities

• Develop and implement KPIs for successful risk adjustment data submissions, managing relationships with vendors and CMS
• Lead the Retrospective Chart Review Program, enforcing SLAs and KPIs while overseeing medical record retrieval and quality assurance processes
• Evaluate and integrate AI technologies to optimize workflows and improve operational efficiency across the Risk Adjustment department

Required qualifications

• Proven experience in transforming complex operational challenges into scalable business processes
• Strong analytical skills with the ability to interpret regulatory guidance and apply it to operations
• Experience managing multiple teams and vendors effectively
• High level of self-motivation and ability to balance multiple priorities
• Familiarity with Medicare Advantage risk adjustment processes is preferred