Senior Director, Risk Adjustment & Coding Strategy

Sacbar; New York, Northern (NY, KY); Hybrid; USD 135,000 - 231,000; Full time

Benefits offered by this job

Comprehensive benefits

Equity stock purchase plan

401(k) contribution

Job summary

Optum NY is seeking an Executive Director of Risk Adjustment to lead enterprise risk adjustment programs across Optum East, NY, and affiliated networks. You will steer strategic execution, ensure compliant risk capture, and influence RAF performance within value-based care models.

You will partner with provider groups, clinical leaders, coding teams, and analytics to embed risk workflows, deliver audits readiness, and optimize documentation.

Qualifications

• 10+ years of experience 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.

Responsibilities

• Lead enterprise risk adjustment strategy for Medicare Advantage, Medicaid, and Commercial risk contracts.
• Drive accurate RAF performance through prospective and retrospective programs.
• Develop multi-year roadmap for risk capture, documentation improvement, and coding optimization.
• Oversee coding programs including chart review, CDI, education, and audit processes.
• Ensure compliance with CMS, HHS, and state regulatory requirements.
• Drive actionable reporting on RAF performance, coding accuracy, and documentation trends.

Skills

Risk Adjustment Expertise

CMS-HCC & ICD-10 Knowledge

Regulatory Compliance

Provider Collaboration

Job description

Optum NY is seeking an Executive Director of Risk Adjustment to lead enterprise risk adjustment programs across Optum East, NY, and affiliated networks. You will steer strategic execution, ensure compliant risk capture, and influence RAF performance within value-based care models.

You will partner with provider groups, clinical leaders, coding teams, and analytics to embed risk workflows, deliver audits readiness, and optimize documentation.