Director, Risk Adjustment Coding - Certified

FlexBoard; India; On-site; INR 13,749,000 - 20,624,000; Full time

Job summary

FlexBoard seeks a Director of Risk Adjustment Coding to provide strategic and operational leadership for the RAD coding function. You will oversee accuracy, governance, and performance across internal teams and vendors, aligning with CMS regulations and audit readiness.

You will lead certified coding teams, establish policies, collaborate with Clinical, Compliance, Operations, Analytics, and Vendor Management, and drive continuous improvement across prospective and retrospective RAD initiatives.

Qualifications

• Bachelor's degree in health information management, nursing, or related field.
• Risk Adjustment coding certification required (CRC or CPC).

Responsibilities

• Lead Risk Adjustment coding programs and leadership across internal teams and vendors.
• Establish and maintain standardized coding policies, procedures, and CMS regulatory documentation.
• Translate Risk Adjustment requirements into coding operations that support accurate RAF capture and audit defensibility.
• Serve as SME for Risk Adjustment coding interpretation and best practices.
• Mentor and develop teams of certified RAD coders and coding leaders.
• Set productivity, accuracy, and benchmarking targets for coding teams.
• Ensure ongoing education on CMS guidance, ICD-10-CM updates, and regulatory changes.
• Partner with Compliance and Audit to ensure CMS RADV audit readiness.

Skills

Leadership

Coding governance

CMS regulations

Audit readiness

Education

Bachelor's degree in health information management / related field

CRC/CPC certification in Risk Adjustment coding

Job description

The Director, Risk Adjustment Coding (Certified)

reputed company reputed company provides strategic and operational leadership for CareMores Risk Adjustment coding function. This role is accountable for the accuracy, reputed company, and performance of reputed company Risk Adjustment coding activities across internal teams and reputed company vendors, ensuring alignment with CMS regulations, audit readiness standards, and CareMores financial and clinical objectives.

How will you reputed company an reputed company & Requirements

The Director will reputed company certified coding teams, establishes coding governance and reputed company programs, partners cross-functionally with Clinical, Compliance, Operations, Analytics, and Vendor Management, and drives reputed company improvement across prospective, reputed company, and retrospective Risk Adjustment initiatives.

Key Responsibilities

• Risk Adjustment Coding reputed company & Leadership reputed company reputed company leadership for Risk Adjustment coding reputed company across reputed company programs, including prospective, reputed company, and retrospective reviews.
• Establish and maintain standardized coding policies, procedures, and documentation practices reputed company with CMS Risk Adjustment regulations.
• Translate Risk Adjustment reputed company into reputed company coding operations that support accurate RAF capture and audit defensibility.
• Serve as the subject matter expert for Risk Adjustment coding interpretation and best practices.
• Team Leadership & Development reputed company, mentor, and reputed company teams of certified Risk Adjustment coders and coding leaders.
• Establish productivity, reputed company, and accuracy benchmarks for internal coding teams.
• Foster a culture of accountability, compliance, and reputed company learning.
• Ensure ongoing reputed company education reputed company to CMS guidance, ICD-10-CM updates, and regulatory changes.
• Audit & Compliance reputed company Design and reputed company Risk Adjustment coding reputed company assurance and audit programs.
• Partner with Compliance and Audit teams to ensure audit readiness for CMS RADV, reputed company audits.
• Review audit findings and reputed company remediation efforts, education initiatives, and process improvements.
• Ensure adherence to regulatory requirements, internal policies, and documentation standards.
• Cross-Functional Collaboration Collaborate with Clinical leadership to reputed company documentation practices with coding requirements.
• Partner with Analytics to monitor coding performance, trends, and financial reputed company.
• Support Operations and Program Management teams to reputed company coding workflows with Risk Adjustment initiatives.
• executive-level reporting and insights reputed company to coding performance and risk capture.
• Process Improvement & Governance Identify opportunities to improve coding efficiency, accuracy, and scalability.
• Implement tools, technology, and workflow enhancements to support coding operations.
• Establish governance structures, escalation reputed company, and decision-making frameworks.
• Ensure consistency of coding practices across markets, programs, and vendors.

Qualifications Education & Certification

• Bachelors degree required (health information management, nursing, or reputed company field preferred) reputed company Risk Adjustmentreputed company coding certification required, such as CRC (Certified Risk Adjustment Coders reputed company (Certified Coding Specialist) CPC (Certified reputed company reputed company) with demonstrated Risk Adjustment expertise.
• Experience Minimum of 710 years of reputed company reputed company experience, with a strong reputed company on Risk Adjustment. At least 5 years of leadership experience managing certified coding teams and/or vendors.
• Demonstrated experience supporting Medicare Advantage Risk Adjustment programs.
• Proven reputed company in audit readiness, compliance reputed company, and performance improvement.

Preferred Qualifications

• Experience in value-based care, managed care, or Medicare Advantage organizations.
• Experience leading both internal and outsourced coding models.
• Strong understanding of CMS Risk Adjustment, HCC models, and audit requirements.
• Ability to translate regulatory guidance into operational execution Clinical documentation expertise.

Compensation $144,367.00 to $216,552.00