Director, Provider Risk Adjustment

 About Us:

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. 

We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.  

JOB SUMMARY:

The Director, Provider Risk Adjustment has a key leadership role responsible for overseeing and driving operational excellence in coding services across both domestic and global teams. This role focuses on the Risk Adjusted and Value-Based Care initiatives, with particular emphasis on Provider documentation and coding. The Director ensures high-quality service delivery for health plans and provider clients, leading all aspects of HIM coding activities, client implementations, and performance management related to contracted deliverables. This individual acts as the primary point of accountability for client success, managing relationships, ensuring adherence to service level agreements (SLAs), and continuously improving operational outcomes through data-driven decision-making and standardized organizational processes.
This is a remote position.

ESSENTIAL DUTIES AND RESPONSIBILITIES: 
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

This is a remote position.

Location: Remote within US only

Travel: less than 25% (Quarterly QVR, Client sites & Conferences)

 

ESSENTIAL DUTIES & RESPONSIBILITIES:

 

Client Management & Service Delivery

• Serve as the primary escalation point and strategic lead for assigned clients.
• Oversee the successful implementation of new clients, including resource planning, onboarding, process mapping, and EMR/project education.
• Maintain overall accountability for contracted deliverables such as coding quality, adherence to project guidelines, data analysis and reporting, and production standards.
• Lead regular client meetings and updates, ensuring transparency and alignment with expectations.
• Ensure timely response to client inquiries and provide proactive issue resolution.

 

Operational Leadership

• Manage and mentor a diverse team of coding professionals across domestic and global locations.
• Ensure compliance with organizational coding standards, policies, and procedures.
• Monitor productivity and quality metrics, identify trends, and implement performance improvement plans as needed.
• Partner with internal stakeholders (e.g., QA, Compliance, IT) to ensure seamless service delivery.
• Lead standing meetings and reporting cycles, providing visibility into key performance indicators (KPIs), risks, and mitigation plans.

 

Strategy & Continuous Improvement

• Identify and implement best practices across teams to drive consistency and excellence.
• Evaluate operational workflows and recommend enhancements to increase efficiency, accuracy, and scalability.
• Support the development and implementation of new coding tools, technologies, and reporting dashboards.
• Collaborate on pricing models and forecasting for resourcing and capacity planning.

 

QUALILFICATIONS:

Required Qualifications:

• Bachelor’s degree in Health Information Management, Health Administration, Finance, or related field (Master’s preferred).
• 10+ years of progressive experience in medical coding or value-based care operations, including 5+ years in a leadership capacity.
• Proven experience in Payer-side operations and risk-based programs.
• Strong understanding of HCC coding practices, coding quality, and regulatory guidelines.
• Demonstrated ability to manage global teams and vendor relationships.
• Excellent organizational, analytical, and communication skills.
• Proficiency in MS Office and data analysis/reporting tools.

 

Knowledge, Skills & Abilities:

• Prefer 5 – 7 years’ experience in Value-based care organizations with risk adjustment programs, strong understanding of payer contracting and reimbursement, as well as programmatic structure, policies, and procedures.
• Experience with telecommuting and electronic medical record systems is highly preferred.
• Ability to work with multiple and diverse clients and projects.
• Ability to work with minimal supervision.
• Ability to supervise and counsel staff in promoting their development to the success of the company.
• Ability to solve problems; collect data, establish facts and draw valid conclusions.
• Ability to interpret an extensive variety of technical and instructions in mathematical and diagram form and deal with several abstract and concrete variables.
• This individual must also possess thorough knowledge of HCC coding documentation requirements for complete and accurate coding and data quality and integrity skills.
• Knowledge of word processing software, spreadsheet software and database software.
• English is required for verbal and written communication
• Strong communications skills, both verbal and written.

 

Preferred Attributes:

• RHIA, RHIT, or CCS certification.
• Experience in a global revenue cycle management company.
• Familiarity with payer reimbursement models and audit functions.
• Process-oriented with strong project and change management skills.
• Strategic thinker with a client-first mindset.

What we offer:

• Competitive annual salary

• Medical/Dental/Vision Insurance

• Equipment provided

• 401k matching program 

• FTO: Flex Unlimited Annual PTO

• Paid Paternity & Maternity leave programs

• 9 paid annual holidays

• Life Insurance

• Long term disability

• Short term disability options

• Tuition reimbursement

• and more!

PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.