Director, Risk Adjustment

Peak Health

. Develop and execute the enterprise risk adjustment strategy and governance framework across all applicable lines of business .

Posted 11/9/2026full-timeRemote • United StatesLeadWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in developing and executing enterprise risk adjustment strategies, overseeing coding quality assurance, and managing regulatory compliance. Proven ability to lead teams, enhance operational efficiency, and communicate effectively with executive leadership.

Highest-signal resume keywords

Healthcare Risk AdjustmentCoding Quality AssuranceLeadership ExperienceRegulatory CompliancePerformance Dashboard Development

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Risk Adjustment MethodologiesCoding StandardsChart ReviewMedical Record RetrievalData ValidationPerformance IndicatorsOperational StrategiesProcess ImprovementsHealthcare AdministrationClinical Documentation

Soft Skills

Excellent CommunicationAnalytical SkillsOrganizational SkillsExecutive LeadershipMentoring

Industry Keywords

Medicare AdvantageIndividual ACAMedicaidCMSRisk Adjustment Data ValidationHealthcare OperationsHealth Information ManagementPublic HealthFinanceHealthcare Administration

About the role

Key responsibilities & impact

Develop and execute the enterprise risk adjustment strategy and governance framework across all applicable lines of business
Monitor regulatory changes and emerging risk adjustment methodologies, translating them into operational strategies and process improvements
Oversee programs supporting accurate diagnosis capture, medical record retrieval, chart review, coding, validation, and submission of risk adjustment data
Establish and maintain coding standards, policies, procedures, and quality requirements across all applicable lines of business
Oversee coding quality assurance, second-level reviews, audits, corrective action processes, coder productivity, key performance indicators, and compliance with applicable CMS, state, federal, and organizational requirements
Develop and deploy risk adjustment value-based programs with key providers
Develop and maintain an enterprise risk adjustment performance dashboard with key performance indicators covering impacts, coding accuracy, chart retrieval, documentation, submission, audit performance, and operational efficiency
Partner with actuarial and finance teams to quantify the impact of risk adjustment operations on risk scores and improve projection accuracy for bids, pricing, forecasting and accruals
Provide executive leadership with regular reporting on performance, risks, opportunities, and recommended actions
Ensure organizational readiness for CMS Risk Adjustment Data Validation (RADV) audits and regulatory reviews
Oversee relationships with external vendors supporting chart retrieval, coding, analytics, and other risk adjustment functions
Lead, develop, and mentor risk adjustment leaders and teams, establishing clear objectives, performance expectations, and professional development plans

Requirements

What you’ll need

Bachelor's degree in healthcare administration, business, health information management, nursing, public health, finance, or a related field
Eight (8) years of progressive experience in healthcare risk adjustment, health plan operations, coding, clinical documentation, or a related discipline
Five (5) years of leadership experience
Excellent communication, analytical, organizational, and executive leadership skills
Ability to manage multiple complex initiatives in a highly regulated and rapidly changing environment
Specific experience managing and leading risk adjustment programs in Medicare Advantage, Individual ACA, and/or Medicaid preferred
Master’s degree in healthcare administration, business, health information management, nursing, public health, finance, or a related field preferred