About this role

Lead the enterprise development of the Risk Adjustment strategy and operation
Set and execute a multi-year Risk Adjustment strategy for Medicare Advantage and ACA Marketplace
Serve as the executive subject matter expert on Risk Adjustment performance, risk score accuracy, and revenue impacts
Lead all Risk Adjustment functions, including Provider documentation and coding strategy
Collaborate closely with Quality Management/STARS team, Medical Management, Population Health, and Clinical Informatics
Lead, mentor, and develop a high-performing Risk Adjustment team, fostering accountability, innovation, and continuous learning.

Bachelor’s degree required; Master’s degree (MBA, MPH, MHA, or similar) strongly preferred
10+ years of progressive experience in Risk Adjustment within a health plan, with direct experience in: Medicare Advantage Risk Adjustment ACA Marketplace Risk Adjustment
5+ years of people leadership experience managing managers and/or senior leaders.
Deep knowledge of: CMS HCC and HHS Risk Adjustment models RADV audits and compliance requirements Coding guidelines (ICD‑10‑CM) and documentation standards
Proven ability to partner with executive leadership and influence enterprise-wide outcomes.
Strong analytical, financial, and communication skills.

Assistant Vice President, Risk Adjustment

Key skills