Director, Risk Adjustment Strategy & Analytics

PacificSource; Tennessee; Remote; USD 127,000 - 216,000; Full time

Job summary

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

The role reports to the Vice President of Quality and Population Health and requires building cross-functional partnerships and driving measurable improvements in documentation and coding accuracy.

Qualifications

• Bachelor’s degree required; advanced degree preferred.
• 5+ years in healthcare risk adjustment with leadership experience.
• Strong knowledge of CMS risk adjustment regulations and coding guidelines.

Responsibilities

• Lead enterprise risk adjustment programs across lines of business.
• Oversee CMS risk adjustment submissions and coding operations.
• Direct analytics, forecasting, and vendor oversight.
• Foster partnerships across Finance, IT, and Population Health to optimize value-based care.
• Ensure audit readiness and regulatory compliance for MA/HHS RADV.

Skills

Risk adjustment

Provider engagement

Data analysis

SQL

SAS

Leadership

Education

Bachelor’s degree

Tools

Epic

Job description

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

The role reports to the Vice President of Quality and Population Health and requires building cross-functional partnerships and driving measurable improvements in documentation and coding accuracy.