Director, Risk Adjustment

WVU Medicine

. 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 leading teams in a highly regulated healthcare environment. Proficient in translating regulatory changes into operational strategies and maintaining compliance with CMS RADV audits.

Highest-signal resume keywords

Healthcare Risk AdjustmentCoding Quality AssuranceLeadership ExperienceRegulatory ComplianceOperational Strategy Development

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Risk Adjustment MethodologiesChart ReviewCoding StandardsData ValidationPerformance Dashboard DevelopmentKPI ManagementMedical Record RetrievalClinical DocumentationProcess ImprovementValue-Based Programs

Soft Skills

Excellent CommunicationAnalytical SkillsOrganizational SkillsExecutive Leadership SkillsMentoring

Industry Keywords

Healthcare AdministrationHealth Plan OperationsCMS RADV AuditsRisk ScoresActuarial Collaboration

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 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
Oversee coding quality assurance, second-level reviews, audits, corrective action processes, coder productivity, KPIs, and compliance
Develop and deploy risk adjustment value-based programs with key providers
Develop and maintain an enterprise risk adjustment performance dashboard
Partner with actuarial and finance teams to quantify operational impact on risk scores and improve projection accuracy
Provide executive leadership with regular reporting on performance, risks, opportunities, and recommended actions
Ensure readiness for CMS RADV audits and regulatory reviews
Oversee external vendors supporting chart retrieval, coding, analytics, and other risk adjustment functions
Lead, develop, and mentor risk adjustment leaders and teams

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
United States of America work location/status indicated