[Hiring] Assistant Vice President, Medicare Risk Adjustment Performance @Alignment Health

Role Description

The Assistant Vice President, Medicare Risk Adjustment Performance provides executive leadership for Alignment's enterprise Risk Adjustment performance strategy and operations. The role is accountable for achieving annual RAF performance objectives, driving provider and market execution, and ensuring Risk Adjustment activities support the organization's financial, operational, and strategic objectives.

• Accountable for enterprise RAF performance outcomes and annual Risk Adjustment targets.
• Responsible for prospective, concurrent, and retrospective Risk Adjustment execution strategies.
• Provides executive oversight for chart retrieval, coding production, provider engagement, and coding submission performance.
• Establishes market and provider performance objectives and monitors achievement of operational results.
• Provides executive reporting and recommendations to senior leadership regarding Risk Adjustment performance, opportunities, risks, and resource needs.
• Oversees strategic vendor partnerships supporting enterprise Risk Adjustment capabilities.

General Duties/Responsibilities (May include but are not limited to):

• Lead the annual operating plan for Medicare risk adjustment performance, including goals, measures, milestones, resources and market-level execution plans.
• Provide leadership across prospective, concurrent and retrospective programs, including annual wellness visit support, suspecting and recapture initiatives, chart retrieval, coding production and submission readiness.
• Establish and monitor performance guidelines for quality, productivity, service levels and financial outcomes; ensure timely executive reporting and action-oriented performance reviews.
• Use risk adjustment analytics, reporting and strategic business analysis to identify opportunities, risks, root causes and interventions across markets, provider groups and programs.

Qualifications

• Ten or more years of progressive experience in managed care, Medicare Advantage, healthcare analytics, healthcare finance, risk adjustment, population health or related operations.
• Experience leading enterprise Risk Adjustment programs across multiple markets and provider arrangements.
• Demonstrated responsibility for financial performance, forecasting, strategic planning, or major business initiatives.
• Proven track record managing executive stakeholders and enterprise-wide programs.
• Seven or more years of people leadership, including development of high-performing analytical or operational teams.
• Bachelor’s degree in healthcare, business, finance, analytics, information systems or a related field, or equivalent relevant experience.
• Advanced degree preferred.
• Demonstrated knowledge of CMS-HCC risk adjustment methodology, Medicare Advantage reimbursement, coding and documentation programs, encounter data, and performance measurement.
• Demonstrated experience designing or leading analytics, reporting, data governance or scalable data infrastructure that supports reporting accuracy, regulatory compliance and audit readiness.
• Experience leading complex cross-functional initiatives and working with executives, providers, vendors, compliance partners and technical teams.
• Experience with risk adjustment forecasting, provider performance analytics, data warehousing, SQL-based analytics or business intelligence platforms.
• Experience supporting multiple government-program lines of business or large, multi-market Medicare Advantage operations.
• Advanced ability to translate complex data into executive-level insights, recommendations and action plans.
• Strong verbal, written, presentation, organization and relationship-management skills.

Requirements

• Must be efficient in Excel and preferred with SQL knowledge.
• Good organization skills.
• Good analytical skills.
• Good interpersonal skills.
• Strong communication skills.

Benefits

• Pay Range: $198,219.00 - $297,329.00
• Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

Company Description

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first.

We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.