AVP Risk Adjustment & Medical Coding Operations

Novelite Rcm; Hyderabad; On-site; INR 5,000,000 - 7,500,000; Full time

Job summary

Novelite Rcm in Hyderabad seeks an Associate Vice President to lead Risk Adjustment & HCC Coding Operations. You will oversee end-to-end programs for Medicare Advantage, managing large teams of coders, auditors, and managers to optimize risk scores and coding accuracy.

The role demands 15+ years in U.S. healthcare with CMS-HCC expertise, strong leadership and client-facing skills to drive governance, budgeting, and continuous improvements.

Qualifications

• 15+ years of progressive experience in U.S. Healthcare, with deep expertise in HCC Risk Adjustment and ICD-10-CM coding.
• Experience in AVP, Senior Director, or Delivery Head level managing enterprise-scale Risk Adjustment ops.
• Proven track record leading large HCC coding operations (300+ FTEs preferred).
• Strong expertise in CMS-HCC models, RADV audits, CDI, and CMS compliance.
• Understanding of E&M documentation, provider education, and risk score optimization.
• Experience in client relationships, governance, SLA/KPI delivery, budgeting, and growth initiatives.

Responsibilities

• Lead end-to-end Risk Adjustment and HCC Coding operations for Medicare Advantage and value-based care programs.
• Manage large teams of coding managers, quality analysts, auditors, and certified coders.
• Drive KPIs: productivity, quality, TAT, SLA adherence, and client satisfaction.
• Ensure CMS, ICD-10-CM, HCC, RADV and regulatory compliance.
• Develop coding quality improvements through audits, education, and feedback.
• Collaborate with clients, physicians, and cross-functional teams to improve documentation accuracy.
• Oversee workforce planning, budgeting, resource allocation, and financial performance.
• Present dashboards and strategic updates to executives and clients.
• Lead process automation, digital transformation, and continuous improvement initiatives.
• Mentor leadership teams and foster accountability and excellence.

Skills

Risk Adjustment

HCC Coding

Medical Coding

ICD-10-CM

Medicare Advantage

CMS Risk Adjustment

Healthcare Operations

Revenue Cycle Management

Coding Quality & Compliance

Medical Coding Audits

Team Management

Client Management

Process Improvement

Leadership

Strategic Planning

Healthcare Analytics

Job description

Job Title: Associate Vice President (AVP) Risk Adjustment & Medical Coding Operations (HCC)

Location: Hyderabad

Industry: US Healthcare | Medical Coding | Risk Adjustment

Job Summary

Results-oriented healthcare operations leader with extensive experience in Risk Adjustment, HCC Coding, ICD-10-CM, and value-based care operations. Proven expertise in leading large-scale medical coding teams, driving operational excellence, ensuring CMS compliance, improving coding accuracy, and delivering high-quality services to U.S. healthcare clients. Skilled in strategic planning, client relationship management, financial oversight, and process improvement.

Key Responsibilities:

• Lead end-to-end Risk Adjustment and HCC Coding operations for Medicare Advantage and other value-based care programs.
• Manage large teams of coding managers, quality analysts, auditors, and certified medical coders.
• Drive operational KPIs including productivity, quality, turnaround time (TAT), SLA adherence, and client satisfaction.
• Ensure compliance with CMS, ICD-10-CM, HCC, RADV, and other regulatory guidelines.
• Develop and implement coding quality improvement initiatives through audits, education, and feedback.
• Collaborate with clients, physicians, and cross-functional teams to improve documentation accuracy and risk score capture.
• Oversee workforce planning, budgeting, resource allocation, and financial performance.
• Present business reviews, operational dashboards, and strategic updates to executive leadership and clients.
• Lead process automation, digital transformation, and continuous improvement initiatives.
• Mentor and develop leadership teams while fostering a culture of accountability and operational excellence.

Required Skills:

• Risk Adjustment
• HCC Coding
• Medical Coding
• ICD-10-CM
• Medicare Advantage
• CMS Risk Adjustment
• Healthcare Operations
• Revenue Cycle Management (RCM)
• Coding Quality & Compliance
• Medical Coding Audits
• Team Management
• Client Management
• Process Improvement
• Workforce Planning
• Leadership
• Strategic Planning
• Healthcare Analytics

Experience & Qualifications:

• 15+ years of progressive experience in U.S. Healthcare, with deep expertise in HCC Risk Adjustment, ICD-10-CM coding, and Medicare Advantage programs.
• Proven experience in an AVP, Senior Director, Delivery Head, or equivalent leadership role, managing enterprise-scale Risk Adjustment operations.
• Demonstrated success in leading large HCC coding operations (300+ FTEs preferred), including Operations, Quality, Audits, Training, and Client Delivery.
• Strong expertise in HCC Risk Adjustment, CMS-HCC models, ICD-10-CM coding guidelines, Medicare Advantage, RADV audits, Clinical Documentation Improvement (CDI), and CMS compliance.
• Thorough understanding of Evaluation & Management (E&M) documentation, provider education, coding quality, productivity management, and risk score optimization.
• Experience in managing client relationships, operational governance, SLA/KPI delivery, workforce planning, budgeting, and business growth initiatives.
• Certified coding credential such as CRC, CPC, CCS, CIC, or equivalent from AAPC or AHIMA is preferred.
• Strong leadership, stakeholder management, client-facing, communication, analytical, and decision-making skills with a proven track record of driving operational excellence and continuous improvement.