VP, Physician Documentation & Value Performance, CDO (Care Delivery Organization)
Core
Strategy, execution, and optimization of Risk Adjustment programs for a Medicare Advantage Care Delivery Organization to maximize revenue accuracy and ensure CMS compliance.
Role type
VP of Risk Adjustment & Value Performance
Builds
Unified Risk Adjustment strategy and provider engagement programs
Domain
US Healthcare / Medicare Advantage / Risk Adjustment
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure
Required skills
Medicare Advantage program strategy, Risk Adjustment (RA) program leadership, HCC coding expertise, CMS regulatory compliance, provider network engagement, multi-year business planning, cross-functional team leadership, data analytics partnership, audit readiness management
Preferred skills
VP-level experience in Medicare Advantage health plans, CMS RADV audit leadership, Medicare Part D operations, Stars/HEDIS program integration
Technologies
CMS RADV, HCC coding frameworks, analytics reporting tools
Responsibilities
Develop and execute multi-year Risk Adjustment business plans; Lead provider network engagement to improve coding accuracy; Build and develop the Risk Adjustment team; Maintain expert regulatory and competitive intelligence; Leverage data and analytics to drive performance improvement; Oversee Risk Adjustment accuracy, audit readiness, and compliance
Seniority
VP, strategic leadership with direct team management
