Define and execute a multi-year Medicare Advantage Risk Adjustment strategy aligned to enterprise growth and compliance objectives
Translate strategy into annual priorities, roadmaps, and measurable execution plans
Strengthen governance, operational discipline, and performance visibility across the function
Ensure full compliance with CMS Risk Adjustment methodologies, RADV requirements, and evolving regulatory guidance
Lead enterprise preparedness for CMS audits and regulatory reviews
Oversee remediation strategies, documentation standards, and defensible governance structures
Partner with medical groups and clinical leadership to drive shared accountability for accurate documentation and HCC capture
Improve workflows that support real-time, actionable information at the point of care
Align Risk Adjustment with Actuarial, Compliance, Product, Clinical Operations, Quality, Pharmacy, and Network teams
Establish and monitor KPIs including RAF accuracy, encounter submission completeness, provider engagement, and documentation quality
Lead and develop a high-performing team through Directors and managers

Bachelor’s Degree in Health Administration, Business Administration, or a related field
15+ years of relevant experience
7+ years of leadership experience within the healthcare sector
7+ years of relevant experience directly tied to Risk Adjustment and documentation and coding accuracy solutions
Extensive experience in payer, hospital, Medicaid/Medicare, provider environment, or managed care settings
Proven ability to influence and lead cross-functional teams in a complex, matrixed environment
In-depth knowledge of Risk Adjustment Payment methodologies and the CMS HCC Model
Strong organizational, analytical, and communication skills
Demonstrated commitment to best practices, continuous process improvement, and effective change management
Ability to travel up to 50%

Vice President, Risk Adjustment

Key skills