[Hiring] Director of Risk Adjustment @PacificSource Health Plans

Role Description

The Director of Risk Adjustment, reporting to the Vice President of Quality and Population Health, is responsible for ensuring accurate, complete, and compliant Risk Adjustment data reporting to CMS and for leading enterprise-wide risk adjustment programs across all lines of business to identify risk exposure and optimization opportunities. This role oversees an Analytic Manager and Coding Manager that are accountable for cross functional operating team model including analytics and reporting, medical record retrieval, retrospective and prospective coding operations, and provider engagement while ensuring adherence to official guidelines and industry best practices.

• Establish and maintain the enterprise risk adjustment strategy, governance, and control framework.
• Develop and implement scalable prospective programs engagement and education programs.
• Support member engagement strategies to strengthen engagement and wrap around services.
• Oversee risk adjustment processes including provider feedback and coding team education.
• Oversee end to end Medicare Advantage risk adjustment submissions.
• Lead the Risk Adjustment Analytic function including risk score and submission monitoring.
• Ensure audit readiness and response for internal and external audits.
• Lead the Risk Adjustment Coding function and core operational workflows.
• Lead people management activities for all risk adjustment roles.
• Direct departmental budgeting and vendor oversight.
• Build strong cross department partnerships.

Qualifications

• Minimum of 5 years of experience in a healthcare setting.
• At least 3 years directly related to risk adjustment.
• 3 years of team management experience.
• Deep knowledge of risk adjustment strategies.
• Experience managing vendor relationships is preferred.
• Preferred experience includes Medicaid, Medicare, and Commercial health plan operations.

Requirements

• Bachelor’s degree required; preferred areas of focus include health-related field, mathematics, statistics or related.
• Advanced degree preferred.

Benefits

• Base Range: $127,338.01 - $216,474.62.

Company Description

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age.

• PacificSource values the diversity of our community.
• Committed to creating and fostering a work environment in which individual differences and diversity are appreciated.