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Vice President, Risk Adjustment

RiskRiskOtherRemoteLeadTeam 1,001-5,000H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

94 days ago

Salary

$175.3K - $249.1K / year

Seniority

Lead

Bachelor Degree15 yrs expEnglish

Job Description

Vice President, Risk Adjustment

Lumeris

• Define and execute a multi-year Medicare Advantage Risk Adjustment strategy aligned to enterprise growth and compliance objectives • Translate strategy into annual priorities, roadmaps, and measurable execution plans • Strengthen governance, operational discipline, and performance visibility across the function • Ensure full compliance with CMS Risk Adjustment methodologies, RADV requirements, and evolving regulatory guidance • Lead enterprise preparedness for CMS audits and regulatory reviews • Oversee remediation strategies, documentation standards, and defensible governance structures • Partner with medical groups and clinical leadership to drive shared accountability for accurate documentation and HCC capture • Improve workflows that support real-time, actionable information at the point of care • Align Risk Adjustment with Actuarial, Compliance, Product, Clinical Operations, Quality, Pharmacy, and Network teams • Establish and monitor KPIs including RAF accuracy, encounter submission completeness, provider engagement, and documentation quality • Lead and develop a high-performing team through Directors and managers

Job Requirements

  • Bachelor’s Degree in Health Administration, Business Administration, or a related field
  • 15+ years of relevant experience
  • 7+ years of leadership experience within the healthcare sector
  • 7+ years of relevant experience directly tied to Risk Adjustment and documentation and coding accuracy solutions
  • Extensive experience in payer, hospital, Medicaid/Medicare, provider environment, or managed care settings
  • Proven ability to influence and lead cross-functional teams in a complex, matrixed environment
  • In-depth knowledge of Risk Adjustment Payment methodologies and the CMS HCC Model
  • Strong organizational, analytical, and communication skills
  • Demonstrated commitment to best practices, continuous process improvement, and effective change management
  • Ability to travel up to 50%

Benefits

  • Medical, Vision and Dental Plans
  • Tax-Advantage Savings Accounts (FSA & HSA)
  • Life Insurance and Disability Insurance
  • Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days)
  • Employee Assistance Program
  • 401k with company match
  • Employee Resource Groups
  • Employee Discount Program
  • Learning and Development Opportunities
  • And much more...

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