Director Risk Adjustment (Peak Health)
Core
Leads enterprise risk adjustment strategy and operations to optimize accurate, complete, and compliant capture and submission of member risk data while supporting regulatory requirements and financial performance.
Role type
Director of Risk Adjustment
Builds
Enterprise risk adjustment strategy, governance framework, and value-based programs with providers
Domain
Healthcare / Health Insurance / Risk Adjustment
Required skills
Strategic planning, regulatory compliance, coding standards, quality assurance, vendor management, financial modeling, executive reporting, team leadership
Preferred skills
Medicare Advantage, Individual ACA, Medicaid program management, multi-line business experience
Technologies
CMS RADV, performance dashboards, analytics tools
Responsibilities
Develop and execute enterprise risk adjustment strategy; monitor regulatory changes; oversee diagnosis capture, chart review, and coding validation; establish coding standards and quality controls; partner with actuarial and finance teams; provide executive leadership reporting; ensure readiness for RADV audits; manage external vendor relationships; lead and mentor risk adjustment teams
Seniority
Director, strategic leadership & operational oversight
