Director of Risk Adjustment & Value-Based Care

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

Job summary

PacificSource seeks a Director of Risk Adjustment to lead enterprise risk adjustment programs across all lines of business. You will manage analytics and coding teams, ensure data accuracy, and drive compliant optimization strategies in collaboration with providers, vendors, and clinical leaders.

The role requires deep CMS risk adjustment knowledge, executive communication, and strong vendor management to improve documentation and reporting across Medicare Advantage, ACA Commercial, and Medicaid

Qualifications

• Minimum 5 years of experience in a healthcare setting with risk adjustment focus
• At least 3 years of direct risk adjustment work and 3 years of team management
• Knowledge of CMS risk adjustment regulations, HHS ACA rules, Medicaid methodologies and CMS coding standards
• Strong data analysis capabilities across large datasets and multiple sources

Responsibilities

• Establish enterprise risk adjustment strategy, governance, and controls across programs
• Develop scalable education programs to improve documentation and diagnosis reporting
• Oversee end-to-end Medicare Advantage risk adjustment submissions and related activities
• Lead Risk Adjustment Analytics including score monitoring, reporting, and reconciliation
• Ensure audit readiness and manage CMS/IVA submissions and appeals
• Oversee Coding function, medical record retrieval, and coding validation
• Manage hiring, coaching, performance, and succession planning for risk adjustment teams
• Manage budget, vendor oversight, contracting, and cross-department alignment
• Collaborate with Finance, IT, Population Health, Clinical Quality, and other departments

Skills

Risk adjustment strategy

Leadership & people management

Executive communication

Analytics & modeling

Vendor management

Cross-functional collaboration

Strategic planning

Education

Bachelor’s degree

Advanced degree preferred

Tools

SQL

SAS

Epic

Job description

PacificSource seeks a Director of Risk Adjustment to lead enterprise risk adjustment programs across all lines of business. You will manage analytics and coding teams, ensure data accuracy, and drive compliant optimization strategies in collaboration with providers, vendors, and clinical leaders.

The role requires deep CMS risk adjustment knowledge, executive communication, and strong vendor management to improve documentation and reporting across Medicare Advantage, ACA Commercial, and Medicaid