AVP, Medicare Risk Adjustment Performance

alignmenthealthcare; United States; On-site; USD 180,000 - 250,000; Full time

Job summary

Alignment Health is seeking an accomplished executive to lead Medicare Risk Adjustment Performance as AVP, guiding enterprise RAF strategy and operations across markets. You will work with Market Operations, Network Management, Finance and Data teams to hit annual RAF targets and support audit readiness.

The role drives prospective, concurrent and retrospective risk adjustment programs, oversees chart retrieval and coding production, and mentors provider engagement and vendor partnerships to

Qualifications

• Proven leadership of enterprise risk adjustment programs.
• Experience driving RAF performance and market execution.
• Strong analytical, reporting, and vendor-management capabilities.

Responsibilities

• Lead annual operating plan for Medicare risk adjustment performance with multi-market execution.
• Oversee prospective, concurrent and retrospective risk adjustment initiatives and chart activities.
• Set performance guidelines, report to senior leadership, and drive action-oriented reviews.
• Manage vendor partnerships, contracts, and service delivery for risk adjustment.
• Develop scalable reporting and analytics to improve audit readiness and visibility.

Skills

Strategic leadership

Executive communication

Data analytics

Cross-functional collaboration

Healthcare industry knowledge

Education

Bachelor's degree in Health Administration, Business, or related field

Job description

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The Assistant Vice President, Medicare Risk Adjustment Performance provides executive leadership for Alignment's enterprise Risk Adjustment performance strategy and operations. The role is accountable for achieving annual RAF performance objectives, driving provider and market execution, and ensuring Risk Adjustment activities support the organization's financial, operational, and strategic objectives.

The AVP leads the development and execution of enterprise prospective, concurrent, and retrospective Risk Adjustment strategies and serves as the executive responsible for operational performance across provider engagement, coding operations, chart retrieval, submission, analytics, vendor management, and revenue realization.

The role partners closely with Market Operations, Network Management, Clinical Operations, Finance, Compliance, and Data & Technology teams to ensure enterprise Risk Adjustment goals are achieved while supporting audit readiness, provider performance improvement, and long-term organizational growth.

Enterprise Accountability

• Accountable for enterprise RAF performance outcomes and annual Risk Adjustment targets.
• Responsible for prospective, concurrent, and retrospective Risk Adjustment execution strategies.
• Provides executive oversight for chart retrieval, coding production, provider engagement, and coding submission performance.
• Establishes market and provider performance objectives and monitors achievement of operational results.
• Provides executive reporting and recommendations to senior leadership regarding Risk Adjustment performance, opportunities, risks, and resource needs.
• Oversees strategic vendor partnerships supporting enterprise Risk Adjustment capabilities.

General Duties/Responsibilities (May include but are not limited to):

• Lead the annual operating plan for Medicare risk adjustment performance, including goals, measures, milestones, resources and market-level execution plans.
• Provide leadership across prospective, concurrent and retrospective programs, including annual wellness visit support, suspecting and recapture initiatives, chart retrieval, coding production and submission readiness.
• Establish and monitor performance guidelines for quality, productivity, service levels and financial outcomes; ensure timely executive reporting and action-oriented performance reviews.
• Use risk adjustment analytics, reporting and strategic business analysis to identify opportunities, risks, root causes and interventions across markets, provider groups and programs.

Finance

• Accountable for partnership with Finance and Actuarial teams to forecast RAF performance, evaluate revenue implications, monitor financial outcomes, and improve forecast accuracy across markets and programs.
• Support bid development, revenue forecasting, and long-range planning activities.
• Evaluate financial impact of provider performance, coding initiatives, and operational investments.
• Provide executive visibility into Risk Adjustment financial performance and variances.

Vendor Ownership

• Establish strategic direction and performance expectations for Risk Adjustment vendors and external partners.
• Oversee vendor contracts, service delivery, productivity, quality, compliance, and business outcomes.
• Ensure vendor capabilities align with enterprise Risk Adjustment strategy and future-state operating models.

Provider Relationships

• Serve as executive sponsor for provider coding performance and documentation improvement initiatives.
• Partner with Network Management, Market Operations and provider leadership to improve enterprise Risk Adjustment outcomes.
• Lead provider performance reviews, corrective action planning, and performance improvement initiatives across delegated and non-delegated arrangements.
• Establish accountability frameworks for IPA, provider and vendor performance.
• Develop scalable reporting, analytical and operational capabilities that improve organizational visibility, support audit readiness and reduce reliance on manual controls.

Data & Technology Strategy

• Partner with DTS and enterprise analytics teams on Risk Adjustment data strategy and reporting capabilities.
• Define business requirements supporting workflow modernization, automation, provider enablement, and enterprise reporting.
• Sponsor technology initiatives that improve scalability, productivity, transparency,