Director, Provider Risk Adjustment

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Director, Provider Risk Adjustment based in United States.

This is a senior leadership opportunity focused on driving operational excellence across provider risk adjustment, HCC coding, and value-based care programs. You will oversee coding services delivered by domestic and global teams while ensuring quality, productivity, compliance, and contractual performance. The role combines strategic client leadership with hands-on operational oversight, making you a key partner for health plans and provider organizations. You will lead implementations, manage complex client relationships, and use performance data to identify risks and opportunities for improvement. The position also plays a central role in standardizing processes, strengthening coding operations, and supporting technology and reporting enhancements. Success requires strong knowledge of risk adjustment and payer-side operations, combined with the ability to lead diverse teams and navigate complex stakeholder environments. This remote role offers the opportunity to shape scalable healthcare operations while contributing directly to better financial and clinical outcomes.

Accountabilities:: Serve as the primary strategic lead and escalation point for assigned health plan and provider clients, maintaining accountability for service quality, delivery, and client satisfaction.

Lead new client implementations, including resource planning, onboarding, process mapping, workflow design, and EMR or project-specific education.

Oversee contracted deliverables covering coding quality, project guidelines, data analysis, reporting, productivity, and production standards.

Lead recurring client meetings, performance reviews, and status updates while ensuring expectations, risks, and priorities remain aligned.

Respond proactively to client needs, resolve issues efficiently, and develop sustainable solutions to service delivery challenges.

Manage, mentor, and develop diverse coding teams across domestic and global locations, fostering accountability, collaboration, and continuous professional growth.

Ensure coding activities consistently follow organizational standards, policies, procedures, regulatory requirements, and HCC documentation guidelines.

Monitor productivity, quality, and operational KPIs; identify trends and implement performance improvement initiatives where required.

Partner with QA, Compliance, IT, and other internal functions to ensure consistent and efficient delivery across programs.

Establish and manage recurring reporting cycles, providing leadership with clear visibility into performance, risks, trends, and mitigation strategies.

Identify and implement best practices that improve consistency, coding accuracy, operational efficiency, scalability, and client outcomes.

Evaluate workflows and recommend enhancements to coding tools, technology platforms, dashboards, and reporting capabilities.

Contribute to pricing models, resource forecasting, capacity planning, and other strategic initiatives supporting sustainable program growth.

Support continuous improvement across risk adjustment and value-based care operations through standardized, data-driven processes.

Requirements:

Bachelor’s degree in Health Information Management, Health Administration, Finance, or a related discipline; a master’s degree is preferred.

10+ years of progressive experience in medical coding, risk adjustment, or value-based care operations, including at least 5 years in a leadership role.

Proven experience with payer-side operations and risk-based healthcare programs.

Strong understanding of HCC coding practices, provider documentation requirements, coding quality, data integrity, and applicable regulatory guidelines.

Preferably 5–7 years of experience within value-based care organizations managing risk adjustment programs, payer contracting, reimbursement, and related program structures.

Demonstrated experience managing global teams, vendors, and multiple complex client relationships.

Strong understanding of payer reimbursement models, audit processes, and revenue cycle operations.

Experience working with electronic medical record systems and distributed or remote teams.

Excellent analytical and problem-solving abilities, including the ability to collect and interpret data, identify trends, establish facts, and develop sound conclusions.

Strong project management, change management, organizational, and prioritization skills.

Ability to work independently with minimal supervision while effectively managing multiple clients, projects, and competing deadlines.

Strong verbal and written communication skills, with the ability to communicate effectively with clients, leadership, coding professionals, and cross-functional partners.

Proficiency with Microsoft Office and data analysis, reporting, spreadsheet, database, and workflow tools.

English proficiency is required for professional verbal and written communication.

Preferred certifications include RHIA, RHIT, or CCS.

Experience within a global revenue cycle management organization is advantageous.

Strategic, process-oriented, and client-focused mindset with a strong commitment to operational excellence.

Benefits:

Competitive annual salary.

Fully remote position within the United States.

Medical, dental, and vision insurance.

Company-provided equipment.

401(k) matching program.

Flexible unlimited PTO.

Paid maternity and paternity leave programs.

9 paid annual holidays.

Life insurance.

Short-term and long-term disability coverage.

Tuition reimbursement.

Professional development and career growth opportunities.

Supportive environment focused on employee development and long-term career growth.

Travel of less than 25%, primarily for quarterly reviews, client-site activities, and industry conferences.

How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best!  Why Apply Through Jobgether?    Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.     #LI-CL1