Director Of Risk Adjustment (Healthcare)

TL;DR

Director of Risk Adjustment (Healthcare): Leading large-scale risk adjustment operations and team management for a healthcare technology platform with an accent on CMS-HCC coding models, regulatory compliance, and operational scalability. Focus on driving AI-enabled coding solutions, optimizing department KPIs, and serving as a strategic advisor for health systems and medical groups.

Location: Must be based in the USA

Salary: $130,000–$150,000

Company

hirify.global provides a Care Enablement Platform that combines AI-powered automation and human expertise to reduce administrative burdens for healthcare provider organizations.

What you will do

• Manage a department of 70+ production coders and auditors, overseeing hiring and organizational design.
• Establish and optimize department KPIs for coding accuracy, compliance, and throughput.
• Serve as the primary operational partner and trusted advisor for external clients including health systems and medical groups.
• Ensure strict adherence to CMS-HCC guidelines, OIG mandates, and audit readiness.
• Partner with product and engineering teams to represent business requirements for AI-enabled risk coding solutions.
• Lead performance reviews and present complex risk adjustment data to executive stakeholders.

Requirements

• Must be based in the USA
• 9+ years of progressive experience in risk adjustment operations within a health plan or provider organization.
• 3–5 years of direct management experience over a large workforce (50+ employees).
• Expert-level understanding of CMS-HCC Medicare risk coding models (EDS, RAPS).
• Active Certified Risk Adjustment Coder (CRC) certification is highly preferred.
• Strong analytical skills with the ability to translate technical coding jargon into business requirements.

Nice to have

• Understanding of Medicaid and Commercial (ACA/Exchange) risk adjustment coding models.
• Experience collaborating with software development teams or UX designers on AI-enabled products.
• Additional certifications such as CPMA, CPC, CCS, or RHIA.

Culture & Benefits

• Competitive benefits package including healthcare and 401(k).
• Paid time off for full-time employees.
• Opportunity to work at the intersection of healthcare operations and AI technology.
• Equal opportunity employer committed to a diverse workforce.