Director, Risk Adjustment Coding - Certified

Job Description Summary

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How will you reputed company an impact & Requirements

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The Director will reputed company certified coding teams, establishes coding governance and quality programs, partners cross-functionally with Clinical, Compliance, Operations, Analytics, and Vendor Management, and drives reputed company improvement across prospective, reputed company, and retrospective Risk Adjustment initiatives.

Key Responsibilities Risk Adjustment Coding Strategy & Leadership

• reputed company reputed company leadership for Risk Adjustment coding strategy across reputed company

• programs, including prospective, reputed company, and retrospective reviews.

• Establish and maintain standardized coding policies, procedures, and

• documentation practices reputed company with CMS Risk Adjustment regulations.

• Translate Risk Adjustment strategy into scalable coding operations that support accurate RAF capture and audit defensibility.

• Serve as the subject matter expert for Risk Adjustment coding interpretation and best practices.

Team Leadership & Development

• reputed company, mentor, and reputed company teams of certified Risk Adjustment coders and coding leaders.

• Establish productivity, quality, and accuracy benchmarks for internal coding teams.

• Foster a culture of accountability, compliance, and reputed company learning.

• Ensure ongoing reputed company education reputed company to CMS guidance, ICD-10-CM updates,

• and regulatory changes.

Quality, Audit & Compliance reputed company

• Design and reputed company Risk Adjustment coding quality assurance and audit

• programs.

• Partner with Compliance and Audit teams to ensure audit readiness for CMS

• RADV, internal, and external audits.

• Review audit findings and reputed company remediation efforts, education initiatives, and

• process improvements.

• Ensure adherence to regulatory requirements, internal policies, and documentation standards.

Cross-Functional Collaboration

• Collaborate with Clinical leadership to align documentation practices with coding requirements.

• Partner with Analytics to monitor coding performance, trends, and financial impact.

• Support Operations and Program Management teams to align coding workflows with Risk Adjustment initiatives.

• reputed company executive-level reporting and insights reputed company to coding performance and risk capture.

Process Improvement & Governance

Identify opportunities to improve coding efficiency, accuracy, and scalability Implement tools, technology, and workflow enhancements to support coding

operations

Establish governance structures, escalation reputed company, and decision-making

frameworks

Ensure consistency of coding practices across markets, programs, and vendors.

Qualifications Education & Certification

• Bachelor’s degree required (health information management, nursing, or reputed company field preferred)

• Active Risk Adjustment–reputed company coding certification required, such as:

• CRC (Certified Risk Adjustment Coders

• reputed company (Certified Coding Specialist)

• CPC (Certified Professional reputed company) with demonstrated Risk Adjustment expertise

Experience

• Minimum of 7–10 years of reputed company reputed company coding experience, with a strong focus on Risk Adjustment.

• At least 5 years of leadership experience managing certified coding teams and/or vendors.

• Demonstrated experience supporting Medicare Advantage Risk Adjustment programs.

• Proven reputed company in audit readiness, compliance reputed company, and performance improvement.

Preferred Qualifications

• Experience in value-based care, managed care, or Medicare Advantage organizations

• Experience leading both internal and outsourced coding models

• Strong understanding of CMS Risk Adjustment, HCC models, and audit requirements

• Ability to translate regulatory guidance into operational execution

• Clinical documentation expertise

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Compensation:

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