Senior Director – Risk Adjustment

Astrana Health

. Develop and execute enterprise-wide risk adjustment and documentation improvement strategies aligned with organizational and value-based care objectives .

Posted 10/5/2026full-timeAlhambra • California • United StatesSenior💰 $160,000 - $195,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in risk adjustment methodologies, healthcare operations, and value-based care strategies, with a strong focus on compliance and financial performance. Proven ability to lead cross-functional teams and drive strategic initiatives that enhance operational efficiency and revenue integrity.

Highest-signal resume keywords

Risk Adjustment MethodologiesHealthcare AnalyticsValue-Based Care InitiativesRegulatory ComplianceFinancial Management

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Risk AdjustmentClinical Documentation ImprovementCoding ComplianceHealthcare OperationsData-Driven Decision MakingPerformance Metrics EvaluationStrategic Initiative DevelopmentOperational Standards ImplementationBudget ManagementProgram Effectiveness Monitoring

Soft Skills

LeadershipCollaborationAnalytical Problem-SolvingCommunicationNegotiation

Certifications & Qualifications

CRCCPCCCSRHIARHIT

Industry Keywords

CMS-HCCMedicare AdvantageACAMedicaidNCQADMHCValue-Based ReimbursementHealthcare ProgramsOperational EfficiencyRevenue Integrity

About the role

Key responsibilities & impact

Develop and execute enterprise-wide risk adjustment and documentation improvement strategies aligned with organizational and value-based care objectives
Establish departmental goals, KPIs, and operational plans to improve risk capture, coding accuracy, provider engagement, and financial performance
Identify opportunities to enhance revenue integrity, operational efficiency, and program effectiveness through innovation and data-driven decision making
Provide leadership on emerging regulatory requirements, risk adjustment methodologies, and industry best practices
Oversee risk adjustment, coding, provider education, documentation improvement, retrospective review, and prospective outreach programs
Ensure consistent implementation of operational standards, workflows, and performance expectations across markets and business units
Lead cross-functional initiatives involving clinical services, provider operations, analytics, quality, compliance, and finance teams
Monitor program outcomes and implement strategic improvements
Manage departmental budgets, workforce planning, resource allocation, and vendor expenditures
Evaluate operational trends, performance metrics, and financial results; implement corrective action plans as needed
Build strategic relationships with executive leadership, provider groups, health plans, vendors, and external stakeholders
Present business performance, strategic recommendations, and operational results to senior leadership and executive stakeholders
Ensure compliance with CMS, NCQA, DMHC, HHS, federal, state, and health plan requirements
Oversee monitoring, audits, and regulatory reviews related to risk adjustment and documentation practices
Lead and develop Senior Managers, Managers, and departmental leadership teams across multiple functional areas
Coach and mentor leaders; oversee recruitment, performance management, employee development, succession planning, and leadership development
Evaluate organizational structure and staffing needs and partner with executive leadership on future workforce requirements
Drive accountability, collaboration, innovation, and continuous improvement
Perform other duties as assigned

Requirements

What you’ll need

Bachelor's degree in Healthcare Administration, Public Health, Business Administration, Nursing, Health Information Management, or related field required
Master's degree preferred
At least 10 years of healthcare operations, risk adjustment, managed care, or population health experience
At least 5 years of progressive leadership experience managing multiple teams or programs
Demonstrated experience leading large-scale value-based care or risk adjustment initiatives
One or more of the following certifications preferred: CRC, CPC, CCS, RHIA, RHIT
Expert knowledge of CMS-HCC, Medicare Advantage, ACA, Medicaid, and value-based reimbursement methodologies
Strong understanding of risk adjustment operations, clinical documentation improvement, coding compliance, and healthcare analytics
Advanced knowledge of CMS, NCQA, DMHC, and other regulatory requirements impacting value-based care programs
Demonstrated ability to develop and execute strategic initiatives that improve organizational and financial performance
Strong business acumen, financial management, and operational leadership capabilities
Exceptional analytical and problem-solving skills with the ability to interpret complex healthcare data and translate findings into actionable strategies
Proven ability to influence and collaborate effectively with executive leaders, physicians, providers, and cross-functional stakeholders
Excellent verbal, written, presentation, and negotiation skills
Strong project management and change management capabilities
Experience leading large, geographically dispersed teams and complex healthcare programs

Benefits

Comp & perks

Remote position with required travel to provider offices across US markets, health plan meetings, organizational events, and corporate offices in Southern California and Houston
Equal Employment Opportunity and Affirmative Action employer
Reasonable accommodation available for applicants with disabilities