Director of Risk Adjustment
I'm currently partnered with a leading, large-scale clinically integrated network in Texas that's looking to bring on a Director of Risk Adjustment to drive enterprise-wide strategy across multiple lines of business.
This is a high-impact, leadership role sitting at the intersection of value-based care, analytics, and provider engagement - owning end-to-end risk adjustment and CDI performance across Medicare Advantage, Medicaid, Commercial, and ACA populations.
What you'll be doing:
- Leading the enterprise RA & CDI strategy, driving accurate HCC capture and sustainable RAF performance
- Building and scaling prospective, concurrent, and retrospective review programs
- Owning audit readiness, validation efforts, and regulatory compliance (CMS, HHS, OIG)
- Partnering closely with analytics/IT to enhance predictive modeling, reporting, and provider insights
- Developing provider education initiatives to improve documentation accuracy and engagement
- Managing vendor relationships, contracts, and overall ROI across RA programs
- Leading and developing a multidisciplinary team across coding, clinical, and analytics functions
- Presenting performance, risk exposure, and strategy to executive leadership
What they're looking for:
- 6+ years of progressive risk adjustment experience
- Proven leadership experience managing teams and enterprise initiatives
- Strong grasp of CMS guidelines, HCC coding, and audit frameworks
- CPC or CRC
- Bachelor's required
Location: Hybrid in the Dallas-Fort Worth area - Relocation assistance may be provided
If you're looking to step into a visible leadership role where you can truly influence outcomes at scale in a value-based environment, this is a great opportunity to explore.
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