Quality Risk Adjustment Advisor

Job Summary

Leading key components of Quality Risk Adjustment programs, the full-time Quality Risk Adjustment Advisor IV will manage prospective programs, chart retrieval, and coding processes while ensuring compliance and optimizing quality outcomes in a remote setting.

Key responsibilities

• Serve as a subject matter expert in Risk Adjustment operations and support chart retrieval and coding processes
• Identify strategies to enhance risk adjustment processes and improve quality metrics, leveraging AI technologies
• Monitor vendor performance and collaborate with cross-functional teams to support operational goals and process improvements

Required qualifications

• Bachelor's degree in Health Administration, Healthcare Management, or a related field required; Master's degree preferred
• Seven (7) years of experience in risk adjustment, medical record review, coding, or quality management required
• Two (2) years of experience with AI solutions in a healthcare setting required
• Leadership experience preferred
• Knowledge of ICD-10 Coding and HCC Risk Adjustment models