Senior Director, Risk Adjustment Market Performance
Core
Provides executive leadership for risk adjustment performance across markets and lines of business, translating strategic priorities into operational execution to improve coding accuracy, documentation quality, and risk score outcomes.
Role type
Senior Director, Risk Adjustment Market Performance
Builds
Risk adjustment strategies and governance frameworks for Medicaid, Medicare, Marketplace, and Commercial lines of business
Domain
Healthcare operations, risk adjustment, managed care, value-based care
Deliverable
dashboards & analysis
Required skills
Risk adjustment operations, provider performance improvement, coding and documentation programs, healthcare analytics, managed care, executive reporting, cross-functional collaboration, root-cause analysis, strategic planning
Preferred skills
Multi-line business experience (Medicaid, Medicare, Marketplace, Commercial), governance framework development, provider engagement, population health, reimbursement methodologies, matrixed organization influence
Technologies
None explicitly stated
Responsibilities
Serve as primary liaison between Enterprise Risk Adjustment and market leadership; Lead market risk adjustment strategies to achieve enterprise objectives; Establish and monitor performance targets for risk score capture and coding accuracy; Identify and prioritize high-impact provider organizations; Build executive-level relationships with provider organizations; Direct cross-functional collaboration across risk adjustment, provider engagement, quality, network management, actuarial, clinical operations, and analytics; Establish governance and accountability frameworks; Develop executive reporting and action plans; Conduct risk assessments and targeted interventions; Advise leadership on provider investments and operating model enhancements
Seniority
Senior Director, executive leadership & strategy
