Director of Risk Adjustment Programs

A company is looking for a Director, Prospective Risk Adjustment Programs. Key Responsibilities Develop and guide the organization's provider-focused risk adjustment strategy in collaboration with various teams Ensure compliance with regulatory requirements and maintain awareness of audit responses Analyze risk-adjusted data to track performance and identify opportunities for improvement Required Qualifications Bachelor's degree in a related field; advanced degree and clinical experience are a plus Minimum of 7+ years of relevant experience in healthcare risk adjustment and at least 3+ years in a leadership role Strong understanding of CMS risk adjustment methodology and healthcare regulations Experience with healthcare data systems and risk adjustment-specific methodologies Certifications such as CPC, CRC, or similar are a plus

Apr 9, 2025 - 17:47

A company is looking for a Director, Prospective Risk Adjustment Programs. Key Responsibilities Develop and guide the organization's provider-focused risk adjustment strategy in collaboration with various teams Ensure compliance with regulatory requirements and maintain awareness of audit responses Analyze risk-adjusted data to track performance and identify opportunities for improvement Required Qualifications Bachelor's degree in a related field; advanced degree and clinical experience are a plus Minimum of 7+ years of relevant experience in healthcare risk adjustment and at least 3+ years in a leadership role Strong understanding of CMS risk adjustment methodology and healthcare regulations Experience with healthcare data systems and risk adjustment-specific methodologies Certifications such as CPC, CRC, or similar are a plus