[Hiring] SVP, Quality, Risk Adjustment, & Documentation @Wellbe Senior Medical

Role Description

The SVP of Quality, Risk Adjustment & Documentation is a senior enterprise leader accountable for integrating and transforming three deeply interdependent functions: clinical quality performance, risk adjustment (RAF), and clinical documentation integrity. This role is revenue-critical; quality scores and RAF scores are the primary drivers of payer performance and financial sustainability in WellBe’s value-based care model.

This is a fix-and-transform mandate. The SVP will be expected to stabilize underperforming operations, establish clear accountability structures, eliminate fragmentation, and build a unified, high-performing function that drives measurable outcomes. The successful leader will bring both strategic vision and hands-on execution capability, with a demonstrated record of improving payer performance in complex, fast-scaling healthcare environments.

Qualifications

• 12+ years of progressive leadership experience in healthcare quality, risk adjustment, clinical documentation, or related functions within value-based care environments.
• 7+ years in a senior leadership role overseeing teams across coding, billing, quality, or risk adjustment.
• Demonstrated success improving payer quality scores (STARS, HEDIS) and RAF performance at an enterprise or multi-market level.
• Proven ability to consolidate fragmented functions and lead cross-functional transformation and operational change.
• Experience managing payer audits (CMS RADV, OIG) and developing risk mitigation strategies.
• Experience working with Medicare Advantage plans, ACOs, or other risk-bearing entities.

Requirements

• Deep expertise in Medicare Risk Adjustment (MRA), RAF score optimization, HCC coding, STARS, HEDIS, and related quality programs.
• Strong understanding of clinical documentation improvement (CDI) principles and their connection to revenue and compliance outcomes.
• Proficiency with data analytics tools (SAS, Tableau, SQL, or proprietary risk adjustment platforms); experience with AI-driven coding tools and EHR optimization preferred.
• Strong financial acumen, with the ability to forecast revenue, identify performance trends, and optimize risk-adjusted performance.
• Proven ability to engage and influence physicians and clinical teams, including training and performance improvement strategies.
• Demonstrated experience building processes, controls, and performance-driven accountability cultures.

Benefits

• Compensation: $250k-$330k
• Location: Remote/Hybrid
• Travel: Up to 20% as business needs require
• Supervisor Responsibilities: 4 Direct Reports and multiple indirects

Company Description

WellBe is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected status.