VP, Physician Documentation & Value Performance, CDO (Care Delivery Organization)

Job Responsibilities

• Develop and Execute the Multi-Year Risk Adjustment Business Plan.
  • Build and execute a multi-year business plan analyzing the interrelationships of products, operations, market dynamics, and program performance.
  • Achieve sustained improvement in RAF accuracy and revenue optimization for the Care Delivery Organization.
• Establish, Track, and Drive Performance Targets and KPIs.
  • Ensure the organization moves from reactive compliance to proactive, forward-looking performance management.
• Lead Provider Network Engagement for Risk Adjustment Performance.
  • Design and execute direct physician engagement strategies improving HCC coding accuracy, clinical documentation quality, and Risk Adjustment performance.
  • Create feedback loops that make documentation improvement sustainable and clinically meaningful.
• Build, Lead, and Develop the Risk Adjustment Team.
  • Direct and develop a high performing team setting clear performance expectations, fostering a culture of accountability and continuous improvement.
  • Invest in the professional growth of every team member.
• Maintain Expert Regulatory and Competitive Intelligence.
  • Serve as the Care Delivery Organization's foremost authority on CMS regulations, federal legislative changes, industry trends, and best practices in Medicare Risk Adjustment.
  • Provide timely, accurate, and actionable intelligence protecting and optimizing the organization's Risk Adjustment posture.
• Leverage Data and Analytics to Drive Performance Improvement.
  • Partner with Analytics, Finance, and IT teams to build and maintain the data infrastructure, reporting tools, and analytical capabilities required to identify Risk Adjustment opportunities, measure program effectiveness, and inform strategic decisions.
  • Ensure Risk Adjustment performance reporting is timely, accurate, and decision-grade.
• Oversee Risk Adjustment Accuracy, Audit Readiness, and Compliance.
  • Manage coding audits, retrospective and prospective review processes, and vendor management for external coding and audit partners.
  • Maintain a state of continuous CMS audit readiness, proactively identify and correct coding inaccuracies, and operate all Risk Adjustment activities in strict compliance with CMS guidelines and organizational standards.

Supervisory Responsibilities

• Directly supervises management-level staff and provides oversight across the broader team through those managers under the CDO.
• Builds and sustains a high performance team culture, including talent acquisition, onboarding, performance management, development planning, and retention for all direct and indirect reports.
• Oversees assigned staff. Responsibilities include: recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and performance management.