Risk Adjustment Executive

Job Summary

Providing executive leadership and strategy for risk adjustment operations, the full-time salaried Risk Adjustment Executive will oversee compliance and performance across Medicare Advantage, Medicaid, and ACA Marketplace lines of business while collaborating with senior leaders and managing vendor relationships.

Key responsibilities

• Oversee all risk adjustment programs ensuring alignment with organizational objectives and regulatory requirements
• Lead program management for chart review initiatives and provider clinical programs, maintaining compliance with coding standards
• Coordinate Risk Adjustment Data Validation (RADV) activities and develop strategies to improve performance and reduce audit exposure

Required qualifications

• At least 12 years of experience in risk adjustment within a managed care environment, with direct accountability for program performance
• Minimum of 7 years in a management or leadership role
• Comprehensive knowledge of CMS HCC risk adjustment methodology and RADV audit processes
• Experience managing risk adjustment programs across multiple lines of business, including Medicare Advantage
• Strong analytical skills to interpret performance data and drive data-informed decision-making