Director of Risk Adjustment & Value-Based Care

PacificSource; United States; Vor Ort; USD 127.000 - 216.000; Vollzeit

Benefits dieser Stelle

Flexible telecommute policy

Medical, vision, and dental insurance

Paid time off and holidays

401(k) plan

Tuition reimbursement and training

Life insurance

Volunteer opportunities

Zusammenfassung

PacificSource seeks a Director of Risk Adjustment to lead enterprise‑wide risk adjustment programs across Medicare Advantage, ACA Commercial, and Medicaid. You will oversee analytics, coding operations, and provider engagement while ensuring compliance with CMS guidelines and industry best practices.

The role collaborates with Finance, IT, Operations, and Quality to optimize documentation and outcomes. The position requires deep domain knowledge, 5+ years in healthcare risk adjustment, and 3+

Qualifikationen

• Minimum of 5 years in healthcare with 3 years in risk adjustment.
• At least 3 years of team management experience.
• Deep knowledge of CMS risk adjustment regulations and ACA/Medicaid rules.
• Experience managing vendor relationships and cross‑functional collaboration.

Aufgaben

• Establish and maintain enterprise risk adjustment strategy, governance, and control framework.
• Develop scalable education programs for documentation and diagnosis reporting.
• Oversee risk adjustment processes including medical record retrieval and coding.
• Lead analytics, reporting, and data reconciliation with Finance and IT.
• Ensure audit readiness and respond to MA and HHS RADV reviews.
• Manage budgeting, vendor oversight, and cross‑department partnerships.

Kenntnisse

Risk adjustment

Leadership

Vendor management

Provider engagement

CMS guidelines

SQL

Communication

Strategic planning

Ausbildung

Bachelor’s degree

Advanced degree preferred

Tools

SQL

SAS

Epic

Jobbeschreibung

PacificSource seeks a Director of Risk Adjustment to lead enterprise‑wide risk adjustment programs across Medicare Advantage, ACA Commercial, and Medicaid. You will oversee analytics, coding operations, and provider engagement while ensuring compliance with CMS guidelines and industry best practices.

The role collaborates with Finance, IT, Operations, and Quality to optimize documentation and outcomes. The position requires deep domain knowledge, 5+ years in healthcare risk adjustment, and 3+