Head of Business Risk

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.
• 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.
• 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.
• 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.

Education: BA/BS or equivalent, preferably in Health Information Management.

• Active Certified Risk Adjustment Coder (CRC) is highly preferred.
• Certified Professional Medical Auditor (CPMA), CPC, CCS, or RHIA are considered.
• Strong analytical data-driven decision-making.
• Communication skills necessary to translate highly technical coding jargon into clear requirements for technology teams and executives.
• 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).
• 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.

Proven experience collaborating with software development teams, UX designers, or engineers to build or optimize AI-enabled risk coding solutions.

Active Certified Risk Adjustment Coder (CRC) is highly preferred.

~Certified Professional Medical Auditor (CPMA), CPC, CCS, or RHIA are considered.

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).