Medicare Risk Adjustment Executive

Job Summary

Providing executive leadership for enterprise Risk Adjustment performance strategy and operations, the full-time salaried Medicare Risk Adjustment Executive will be accountable for achieving annual RAF performance objectives, driving provider engagement, and ensuring alignment with the organization's financial and operational goals while working remotely.

Key responsibilities

• Lead the development and execution of Risk Adjustment strategies, ensuring operational performance across coding, chart retrieval, and provider engagement
• Oversee financial forecasting and performance evaluation in collaboration with Finance and Actuarial teams, supporting bid development and long-range planning
• Establish and monitor performance guidelines for quality and productivity, providing executive reporting and recommendations to senior leadership

Required qualifications

• Ten or more years of experience in managed care, Medicare Advantage, healthcare analytics, or related operations
• Proven experience leading enterprise Risk Adjustment programs across multiple markets and provider arrangements
• Bachelor's degree in healthcare, business, finance, analytics, or a related field; advanced degree preferred
• Demonstrated knowledge of CMS-HCC risk adjustment methodology and Medicare Advantage reimbursement processes
• Experience with risk adjustment forecasting, provider performance analytics, and data governance