Executive Director of Risk Adjustment

Colorado Psychiatric; New York (NY); On-site; USD 135,000 - 231,000; Full time

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase

401k contribution

Job summary

Optum NY in New York, NY seeks an Executive Director of Risk Adjustment to lead enterprise-wide risk adjustment programs across the organization. You will drive strategy for Medicare Advantage, Medicaid, and Commercial contracts, and align risk capture with clinical workflows.

Collaborate with provider groups, coding teams, and leadership to improve documentation, coding accuracy, and audit readiness while ensuring regulatory compliance and strong financial performance.

Qualifications

• 10+ years of expereince in risk adjustment, coding, or value-based care.
• Deep expertise in CMS-HCC, ICD-10, and documentation standards.
• Experience working with provider organizations in risk-bearing models.
• Strong knowledge of regulatory audits and compliance frameworks.

Responsibilities

• Lead enterprise risk adjustment strategy for Medicare Advantage, Medicaid, and Commercial risk contracts.
• Drive accurate and sustainable RAF performance through prospective and retrospective programs.
• Develop multi-year roadmap for risk capture, documentation improvement, and coding optimization.
• Serve as a strategic advisor to provider groups on documentation and coding performance.
• Partner with physician leaders and practice executives to embed risk workflows into care delivery.
• Oversee coding programs including chart review, CDI, education, and audit processes.
• Ensure adherence to ICD-10, CMS-HCC, and state-specific risk methodologies.
• Standardize best practices across employed and independent networks.
• Ensure compliance with CMS, HHS, and state regulatory requirements.
• Partner with compliance and legal on audits, RADV readiness, and corrective actions.
• Drive actionable reporting on RAF performance, coding accuracy, and documentation trends.
• Implement dashboards to track prospective and retrospective program effectiveness.
• Standardize workflows across coding, chart abstraction, and outreach activities.
• Improve efficiency and reduce provider abrasion tied to documentation processes.
• Coordinate with Quality teams to align provider touchpoints where appropriate.
• Partner with finance and actuarial teams to model and track RAF impact.
• Ensure providers understand financial implications of risk capture performance.
• Support success in shared savings, capitation, and global risk contracts.
• Lead high-performing teams across coding, CDI, analytics, and risk operations.

Skills

Risk adjustment

Coding

Value-based care

CMS-HCC

ICD-10

Regulatory audits

Compliance frameworks

Provider engagement

Job description

Optum NY, is seeking an Executive Director of Risk Adjustment join our team in New York, NY. Optum is a clinician-led care organization that is changing the way clinicians work and live.

As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone.

At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives.

We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.

The Executive Director of Risk Adjustment is responsible for leading the strategic execution and operational performance of enterprise-wide risk adjustment programs across Optum East. This role ensures accurate, compliant, and sustainable risk capture across employed and contracted provider networks, directly impacting financial performance in value-based arrangements.

This leader partners closely with provider organizations, clinical leadership, coding teams, and enterprise stakeholders to embed risk capture into clinical workflows while maintaining regulatory compliance and audit readiness.

Primary Responsibilities:

• Risk Adjustment Strategy & Execution
  • Lead enterprise risk adjustment strategy for Medicare Advantage, Medicaid, and Commercial risk contracts
  • Drive accurate and sustainable RAF performance through prospective and retrospective programs
  • Develop multi-year roadmap for risk capture, documentation improvement, and coding optimization
• Provider Partnership & Engagement
  • Serve as a strategic advisor to provider groups on documentation and coding performance
  • Partner with physician leaders and practice executives to embed risk workflows into care delivery
  • Co-develop actionable performance plans to close documentation and coding gaps
• Coding Excellence & Program Oversight
  • Oversee coding programs including chart review, CDI, education, and audit processes
  • Ensure adherence to ICD-10, CMS-HCC, and state-specific risk methodologies
  • Standardize best practices across employed and independent networks
• Compliance & Audit Readiness
  • Ensure compliance with CMS, HHS, and state regulatory requirements
  • Partner with compliance and legal on audits, RADV readiness, and corrective actions
  • Serve as escalation point for risk-related regulatory matters
• Data, Analytics & Reporting
  • Drive actionable reporting on RAF performance, coding accuracy, and documentation trends
  • Partner with analytics teams to identify risk opportunities and provider-level insights
  • Implement dashboards to track prospective and retrospective program effectiveness
• Operational Effectiveness
  • Standardize workflows across coding, chart abstraction, and outreach activities
  • Improve efficiency and reduce provider abrasion tied to documentation processes
  • Coordinate with Quality teams to align provider touchpoints where appropriate
• Financial Performance Alignment
  • Partner with finance and actuarial teams to model and track RAF impact
  • Ensure providers understand financial implications of risk capture performance
  • Support success in shared savings, capitation, and global risk contracts
• Team Leadership
  • Lead high-performing teams across coding, CDI, analytics, and risk operations
  • Build a culture of accountability, compliance, and continuous improvement

Key Performance Indicators (KPIs):

• RAF accuracy and year-over-year improvement
• Coding accuracy and audit results
• Provider engagement in risk programs
• Closure of suspect and retrospective gaps
• Financial performance tied to risk adjustment
• Regulatory compliance and audit outcomes

Required Qualifications:

• 10+ years of expereince in risk adjustment, coding, or value-based care
• Experience working with provider organizations in risk-bearing models
• Deep expertise in CMS-HCC, ICD-10, and documentation standards
• Solid understanding of regulatory audits and compliance frameworks

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $134,600 - $230,800 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.