Director, Risk Adjustment (Healthcare)

TL;DR

Director, Risk Adjustment (Healthcare): Driving risk adjustment performance across payer and government programs with an accent on RAF improvement, recapture performance, and coding accuracy. Focus on designing scalable risk adjustment strategies, leveraging AI/NLP for data enrichment, and managing cross-functional execution.

Location: Remote (United States)

Company

A kidney care management company partnering with physicians to reimagine healthcare through expertise and scale.

What you will do

• Lead the development and execution of enterprise-wide risk adjustment strategies aligned with clinical and financial priorities.
• Operationalize longitudinal patient-level tracking for suspected and recaptured conditions to enable proactive gap management.
• Leverage analytics, predictive modeling, and AI/NLP to enhance suspecting logic and increase targeting precision.
• Expand risk adjustment execution beyond nephrology by engaging PCPs, health plans, and in-home programs.
• Establish KPIs and dashboards to translate RAF performance into measurable financial impact (PMPM, revenue lift).
• Lead and develop a high-performing team responsible for risk adjustment operations and delivery.

Requirements

• 8–12+ years of experience in risk adjustment, healthcare operations, or a related field.
• Deep expertise in Medicare Advantage risk adjustment, HCC coding, and RAF methodology.
• Experience leading enterprise or multi-market risk adjustment programs.
• Proven ability to translate strategy into execution and measurable financial outcomes.
• Demonstrated success leading cross-functional initiatives in complex healthcare environments.
• Must be based in the United States.

Nice to have

• Bachelor’s degree in a related field of study.

Culture & Benefits

• 100% remote work environment.
• Mission-driven culture focused on compassion, humility, and collaboration.
• Strong commitment to diversity, equity, and inclusion.
• Opportunity to work in a highly regulated environment utilizing advanced analytics and AI.