Senior Risk Adjustment Leader: Strategy & Coding

Texas Health Institute; New York (NY); Hybrid; USD 135,000 - 231,000; Full time

Benefits offered by this job

Comprehensive benefits

Equity stock purchase

401k contributions

Job summary

Optum NY is seeking an Executive Director of Risk Adjustment to lead enterprise-wide risk adjustment programs across Optum East. This role drives accurate RAF performance, embeds risk workflows into clinical care, and partners across provider networks to ensure compliant and sustainable risk capture.

The leader will oversee coding, CDI, analytics, and audit processes, aligning with CMS-HCC and ICD-10 standards while driving performance improvements and regulatory readiness.

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 and sustainable 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 adherence to ICD-10, CMS-HCC, and state-specific risk methodologies.

Skills

Risk adjustment

Coding

Value-based care

CMS-HCC

ICD-10

Regulatory audits

Job description

Optum NY is seeking an Executive Director of Risk Adjustment to lead enterprise-wide risk adjustment programs across Optum East. This role drives accurate RAF performance, embeds risk workflows into clinical care, and partners across provider networks to ensure compliant and sustainable risk capture.

The leader will oversee coding, CDI, analytics, and audit processes, aligning with CMS-HCC and ICD-10 standards while driving performance improvements and regulatory readiness.