Director, Risk Adjustment

About the role

For our client, we are seeking a Director, Risk Adjustment to join the team of a leader in the Finance & Insurance space. This role will own enterprise-wide risk adjustment strategy, governance, and execution across healthcare operations. The Director will lead cross-functional efforts to strengthen coding, analytics, education, audit readiness, and member engagement in support of improved health outcomes and operational quality. This position also partners with internal teams and external vendors to advance scalable processes, ensure compliant data submission, and support continuous improvement across the organization. Location: Remote - US based candidates only, no visa sponsorship available.

Responsibilities

• Establish and maintain the enterprise risk adjustment strategy and governance framework
• Develop scalable engagement and education programs for continuous quality improvement
• Support member engagement strategies to enhance health outcomes
• Oversee risk adjustment processes and collaborate on annual education strategies
• Lead risk adjustment analytic functions, including monitoring and reporting
• Ensure audit readiness for internal and external audits, overseeing documentation standards
• Manage risk adjustment coding functions and operational workflows

Qualifications

• 5+ years of healthcare experience, including 3+ years in risk adjustment and team management
• Deep knowledge of risk adjustment strategies and data submission guidelines
• Experience managing vendor relationships and familiarity with pricing models
• Preferred experience in Medicaid, Medicare, and Commercial health plan operations
• Bachelor's degree required; advanced degree preferred in a health-related field, mathematics, or statistics

Benefits

• Comprehensive health insurance options
• Retirement savings plan with employer match
• Professional development opportunities and training
• Flexible work environment with remote options
• Paid time off and holiday leave

Pay

Compensation: $127,338 – $216,474 annually