Director of Risk Adjustment & Data Strategy

PacificSource; United States; Remote; USD 127,000 - 216,000; Full time

Job summary

PacificSource seeks a seasoned Director of Risk Adjustment to lead enterprise risk adjustment programs across all lines of business. You will oversee analytics, coding, and provider engagement, ensuring data accuracy and CMS compliance while driving continuous quality improvement.

You will manage cross-functional teams, partner with Finance, IT and Population Health, and shape education strategies for documentation and diagnosis reporting.

Qualifications

• Bachelor’s degree required; advanced degree preferred.
• Extensive knowledge of CMS risk adjustment regulations and reporting.
• Experience leading analytics, coding, and provider engagement teams.

Responsibilities

• Establish enterprise risk adjustment strategy and governance.
• Oversee risk adjustment processes including coding, analytics, and vendor oversight.
• Lead education programs dedicated to improving documentation and diagnosis reporting with measurable goals.
• Ensure audit readiness for MA and HHS RADV, including documentation and CMS feedback handling.
• Collaborate with Finance, IT, Operations and Quality to optimize data and processes.

Skills

Leadership

Risk adjustment

CMS regulations

SQL

Data analysis

Communication

Strategic planning

Healthcare operations

Vendor management

Education

Bachelor's degree

Advanced degree

Tools

Epic Systems

Job description

PacificSource seeks a seasoned Director of Risk Adjustment to lead enterprise risk adjustment programs across all lines of business. You will oversee analytics, coding, and provider engagement, ensuring data accuracy and CMS compliance while driving continuous quality improvement.

You will manage cross-functional teams, partner with Finance, IT and Population Health, and shape education strategies for documentation and diagnosis reporting.