Director, Risk Adjustment & Analytics

PacificSource; Springfield (OR); On-site; USD 127,000 - 216,000; Full time

Job summary

PacificSource is seeking 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, medical record retrieval, and provider engagement, ensuring compliance with CMS guidelines.

Collaboration with Finance, IT, and Quality is essential to optimize value and accuracy. Ideal candidates have 5+ years in healthcare risk adjustment and 3+ years of leadership, with strong knowledge

Qualifications

• Minimum of 5 years of healthcare experience, including risk adjustment.
• At least 3 years directly related to risk adjustment and 3 years of manager/leadership experience.
• Bachelor's degree required; advanced degree preferred.

Responsibilities

• Establish and maintain enterprise risk adjustment strategy and governance.
• Develop scalable risk adjustment programs and provider engagement initiatives.
• Oversee risk adjustment coding and documentation improvements.
• Lead end-to-end Medicare Advantage risk adjustment submissions and related activities.
• Manage budgeting, vendor oversight, and cross-department partnerships.

Skills

Executive-level communication

CMS risk adjustment knowledge

SQL

SAS

Data analysis

Education

Bachelor's degree

Advanced degree preferred

Tools

Epic

Job description

PacificSource is seeking 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, medical record retrieval, and provider engagement, ensuring compliance with CMS guidelines.

Collaboration with Finance, IT, and Quality is essential to optimize value and accuracy. Ideal candidates have 5+ years in healthcare risk adjustment and 3+ years of leadership, with strong knowledge