Director Risk Adjustment

Role Description

Job Description: Director of Risk Adjustment

• Strategic Client Management:
  • Serve as the primary operational partner for multiple external clients across medical groups, health systems, and risk-bearing entities.
  • Serve as the trusted advisor and escalation point.
  • Lead regular performance reviews.
  • Present complex risk adjustment data.
  • Ensure strict adherence to Service Level Agreements (SLAs).
• Team Leadership & Scalability:
  • Directly manage a department of 70+ production coders and auditors.
  • Lead the organizational design and hiring strategy to expand the team as the company grows into new business lines.
• Operational Excellence:
  • Establish, monitor, and optimize department KPIs regarding coding/auditing accuracy, compliance, daily volume throughput, and turnaround times across all active risk adjustment models.
• Regulatory Alignment:
  • Act as the internal authority on CMS-HCC coding updates.
  • Ensure all risk adjustment programs strictly adhere to current guidelines, OIG mandates, and RADV/HHS-RADV audit readiness.
• Product & Technology Collaboration:
  • Partner cross-functionally with the Product team as the primary business stakeholder representing coding, auditing, and regulatory best practices.
  • Optimize model performance and user experience.

Qualifications

• Education: BA/BS or equivalent, preferably in Health Information Management.
• Certifications:
  • Active Certified Risk Adjustment Coder (CRC) is highly preferred.
  • Certified Professional Medical Auditor (CPMA), CPC, CCS, or RHIA are considered.
• Core Competencies:
  • Exceptional operational execution across a large span of control.
  • Strong analytical data-driven decision-making.
  • Communication skills necessary to translate highly technical coding jargon into clear requirements for technology teams and executives.
• Experience & Leadership:
  • 9+ years of progressive experience in risk adjustment operations within a health plan, provider organization, or vendor.
  • 3–5 years of direct management experience over a large workforce (50+ coders and auditors).
• Subject Matter Expert:
  • Expert-level understanding of the end-to-end CMS-HCC Medicare risk coding model, including prospective, concurrent, and retrospective coding, including EDS and RAPS.
• Multi-Line Coding Knowledge (Plus):
  • A strong understanding or background in Medicaid and Commercial (ACA/Exchange) risk adjustment coding models is a plus.
• Product & Technical Savvy:
  • Proven experience collaborating with software development teams, UX designers, or engineers to build or optimize AI-enabled risk coding solutions.

Requirements

• Active Certified Risk Adjustment Coder (CRC) is highly preferred.
• Certified Professional Medical Auditor (CPMA), CPC, CCS, or RHIA are considered.

Benefits

• The maximum annual salary range is $130,000 - $150,000 a year, determined by years of relevant experience, skills, and the specific geographical location where the work is performed.
• Pay is based on several factors, including but not limited to current market conditions, location, education, work experience, certifications, etc.
• IKS Health offers a competitive benefits package including healthcare, 401(k), and paid time off (all benefits are subject to eligibility requirements for full-time employees).