Director of Burden of Illness & Risk Adjustment

(Mosaic Shared Services) Millennium Healthcare Management Serv LLC; Florida; Hybrid; USD 137,000 - 206,000; Full time

Job summary

Mosaic Health is seeking a Director to lead Burden of Illness initiatives across physician practices, translating BOI strategy into actionable programs. You will supervise a team and collaborate with Risk Adjustment, Population Health, and Clinical Operations to ensure compliant, measurable outcomes.

Ideal candidates have 7+ years in Medicare Risk Adjustment with leadership experience and strong CMS-HCC knowledge.

Qualifications

• Bachelor's degree in Healthcare Administration, Business Administration, Health Information Management, Public Health, preferred; or equivalent combination of education and relevant professional experience may be considered.
• Active CRC or CPC certification strongly preferred.
• Minimum of 7 years of progressive experience in Medicare Risk Adjustment, Burden of Illness, population health, or related healthcare operations.
• Minimum of 3–5 years of leadership experience.
• Strong experience with CMS-HCC Risk Adjustment methodologies and reporting requirements.
• Experience working with physician practices and provider leadership.
• Experience with Medicare Advantage and value-based care arrangements required; ACO and risk-bearing arrangements preferred.
• Demonstrated experience using healthcare data to identify opportunities and drive measurable performance improvement.
• Experience with analytical and reporting tools such as Excel, SQL, Tableau, Power BI, or similar platforms preferred.

Responsibilities

• Provide leadership and subject matter expertise for organizational Burden of Illness initiatives.
• Maintain knowledge of CMS-HCC methodologies, regulatory requirements, coding guidelines, and changes affecting BOI performance.
• Monitor key BOI indicators.
• Identify patterns in documentation and coding performance requiring provider or practice intervention.
• Ensure provider education strategies address identified documentation and coding opportunities.
• Establish BOI priorities for physician practices based on performance data and identified opportunities.
• Develop the framework teams use to execute BOI initiatives within practices.
• Segment and prioritize practices and providers based on level of support required.
• Monitor practice and provider progress against established BOI goals.
• Identify systemic barriers affecting practice execution and coordinate solutions across the organization.
• Develop scalable workflows that integrate BOI activities into routine practice operations.
• Ensure practice-facing BOI activities are coordinated to minimize disruption and improve provider engagement.
• Partner with partnership and market operation leadership to understand priorities, performance opportunities, and partner expectations related to BOI.
• Monitor BOI performance across populations and identify opportunities requiring intervention.
• Develop targeted improvement strategies based on identified performance gaps.
• Participate in performance discussions when BOI expertise or leadership is required.
• Ensure BOI initiatives supporting are appropriately prioritized, tracked, and executed.

Skills

Risk Adjustment

CMS-HCC methodologies

Provider engagement

Executive communication

Strategic planning

Leadership

Data interpretation

Education

Bachelor's degree in Healthcare Administration or related field

CRC or CPC certification preferred

Tools

Excel

SQL

Tableau

Power BI

Job description

Mosaic Health is seeking a Director to lead Burden of Illness initiatives across physician practices, translating BOI strategy into actionable programs. You will supervise a team and collaborate with Risk Adjustment, Population Health, and Clinical Operations to ensure compliant, measurable outcomes.

Ideal candidates have 7+ years in Medicare Risk Adjustment with leadership experience and strong CMS-HCC knowledge.