Director - Risk Adjustment & Medical Coding Operations (Hyderabad)

Novelite Rcm; Hyderabad; On-site; INR 6,000,000 - 10,000,000; Full time

Job summary

Novelite Rcm is seeking an experienced Director of Risk Adjustment & Medical Coding Operations (HCC) to lead end-to-end HCC coding for U.S. healthcare clients in Hyderabad.

This role focuses on delivering CMS-compliant results, driving operational excellence, and managing client relationships with a high-performing team. You will oversee Coding Managers, QA, Trainers, and Coders to ensure accuracy, timely delivery, and adherence to RADV and Medicare Advantage requirements, while guiding

Qualifications

• 12+ years in U.S. Healthcare with Risk Adjustment (HCC) and Medical Coding Operations.
• 3+ years in a leadership role (Director/Associate Director/Senior Manager) managing HCC coding operations.
• Experience managing large coding teams (150–300+ FTEs preferred).
• CRC, CPC, CCS, CIC or equivalent AAPC/AHIMA certification is preferred.

Responsibilities

• Lead end-to-end HCC Risk Adjustment operations for Medicare Advantage and value-based care programs.
• Manage Coding Managers, Quality Auditors, Trainers, Team Leads, and Certified HCC Coders to achieve operational excellence.
• Drive productivity, quality, coding accuracy, turnaround time (TAT), SLA adherence, and client satisfaction.
• Ensure CMS-HCC, ICD-10-CM coding guidelines, Medicare Advantage regulations, and RADV audit requirements.
• Develop strategies to improve coding accuracy, documentation quality, risk score capture, and operational efficiency.
• Collaborate with clients, providers, and internal stakeholders to support quality and compliance initiatives.
• Lead workforce planning, capacity management, budgeting, resource allocation, and performance governance.
• Present business reviews, operational metrics, and improvement plans to senior leadership and clients.
• Drive continuous improvement, automation, and process optimization initiatives.
• Mentor and develop leadership teams while fostering a culture of accountability and high performance.

Skills

HCC Risk Adjustment

CMS-HCC & Medicare Advantage

ICD-10-CM Coding

RADV Audits

Clinical Documentation Improvement

Quality & Compliance

Operations Management

Client Relationship Management

People Leadership

Process Improvement

Operational Excellence

Performance Management

Budgeting & Resource Planning

Job description

Job Title: Director - Risk Adjustment & Medical Coding Operations (HCC)

Location: Hyderabad

Industry: US Healthcare | Medical Coding | Risk Adjustment

Job Summary

We are seeking an experienced and agile Director Risk Adjustment & Medical Coding Operations (HCC) to lead end-to-end HCC coding operations for U.S. healthcare clients. The role is responsible for driving operational excellence, ensuring CMS compliance, managing client relationships, leading high-performing teams, and delivering quality outcomes aligned with organizational goals.

Key Responsibilities

• Lead and oversee end-to-end HCC Risk Adjustment operations for Medicare Advantage and value-based care programs.
• Manage Coding Managers, Quality Auditors, Trainers, Team Leads, and Certified HCC Coders to achieve operational excellence.
• Drive productivity, quality, coding accuracy, turnaround time (TAT), SLA adherence, and client satisfaction.
• Ensure compliance with CMS-HCC, ICD-10-CM coding guidelines, Medicare Advantage regulations, and RADV audit requirements.
• Develop strategies to improve coding accuracy, documentation quality, risk score capture, and operational efficiency.
• Collaborate with clients, providers, and internal stakeholders to support quality and compliance initiatives.
• Lead workforce planning, capacity management, budgeting, resource allocation, and performance governance.
• Present business reviews, operational metrics, and improvement plans to senior leadership and clients.
• Drive continuous improvement, automation, and process optimization initiatives.
• Mentor and develop leadership teams while fostering a culture of accountability and high performance.

Experience & Qualifications

• 12+ years of experience in U.S. Healthcare, with significant expertise in Risk Adjustment (HCC) and Medical Coding Operations.
• 3+ years of experience in a leadership role such as Director, Associate Director, Senior Manager, or equivalent, managing HCC coding operations.
• Experience managing large coding teams (150300+ FTEs preferred).
• Strong knowledge of CMS-HCC, ICD-10-CM coding guidelines, Medicare Advantage, RADV, Clinical Documentation Improvement (CDI), and value-based care programs.
• Proven experience in client management, operational governance, workforce planning, quality management, and process improvement.
• CRC, CPC, CCS, CIC, or equivalent AAPC/AHIMA certification is preferred.
• Excellent leadership, communication, stakeholder management, analytical, and client-facing skills.

Preferred Skills

• HCC Risk Adjustment
• CMS-HCC & Medicare Advantage
• ICD-10-CM Coding
• RADV Audits
• Clinical Documentation Improvement (CDI)
• Quality & Compliance
• Operations Management
• Client Relationship Management
• People Leadership
• Process Improvement & Operational Excellence
• Performance Management
• Budgeting & Resource Planning