Medicaid Risk Adjustment Director

Job Summary

Providing strategic and operational leadership, the full-time remote Medicaid Risk Adjustment Director will oversee Medicaid risk adjustment analytics, reporting, and informatics functions, ensuring compliance and accuracy in revenue capture while leading a multidisciplinary team.

Key Responsibilities

• Define and execute Medicaid risk adjustment strategy, aligning programs with state Medicaid models and driving high-impact initiatives
• Oversee health plan performance analytics, developing scalable data pipelines and ensuring accuracy of Medicaid encounter submissions
• Establish processes for risk score integrity, leading reconciliation efforts and ensuring readiness for state audits and external reviews

Required Qualifications

• 10+ years of experience in healthcare analytics and reporting, with a focus on risk adjustment and claims knowledge
• 3+ years of leadership experience in managing and mentoring teams
• Advanced technical skills in SAS, SQL, Python, or cloud-based analytics platforms
• Expertise in state regulatory requirements and risk adjustment methodologies
• Strong knowledge of risk models and state reconciliation processes