Lead, Organic Risk Adjustment

Accountabilities: The Lead, Organic Risk Adjustment will be responsible for designing, launching, and improving programs that enhance documentation quality, risk capture, and overall operational performance. This role requires a combination of strategic thinking and hands-on execution, with a focus on building scalable processes and driving collaboration across healthcare teams.

Build and operationalize organic risk adjustment programs designed to improve performance and documentation accuracy.

Develop workflows, playbooks, provider engagement strategies, and reporting processes from initial design through implementation.

Identify improvement opportunities, create action plans, and drive initiatives to successful completion.

Manage multiple projects simultaneously while ensuring timelines, objectives, and performance goals are achieved.

Serve as the operational owner for day-to-day execution of risk adjustment initiatives.

Partner with providers, practice leaders, clinical teams, and operational stakeholders to improve documentation and coding outcomes.

Create practical solutions that integrate effectively into existing clinical workflows.

Lead stakeholder meetings, coordinate action items, and maintain accountability across teams.

Analyze healthcare data to identify documentation gaps, risk capture opportunities, and performance trends.

Translate analytical insights into actionable improvement plans and measurable operational outcomes.

Monitor program results, evaluate effectiveness, and adjust approaches based on performance data.

Requirements:

The ideal candidate brings extensive experience in healthcare operations, risk adjustment, and cross-functional program leadership. Success in this role requires strong analytical abilities, excellent stakeholder management skills, and the ability to execute initiatives in a complex healthcare environment.

Bachelor’s degree or equivalent professional experience.

6+ years of related lead-level experience in healthcare operations, risk adjustment, clinical documentation improvement, coding, quality, or value-based care.

Experience with Medicare Advantage risk adjustment programs and RAF performance improvement.

Proven ability to lead cross-functional initiatives involving clinical, coding, analytics, quality, and operational teams.

Experience developing provider education programs, documentation improvement strategies, and performance feedback processes.

Strong analytical skills with the ability to identify trends, uncover root causes, and translate insights into action plans.

Excellent communication, facilitation, and stakeholder management abilities.

Ability to manage multiple priorities and deliver results in a fast-paced, highly regulated environment.

Experience with organic or prospective risk adjustment programs is preferred.

Familiarity with provider-facing documentation workflows, EMR-based interventions, suspect condition programs, or point-of-care gap closure strategies is a plus.

Experience creating dashboards, executive reporting, or performance scorecards is preferred.

Knowledge of Medicare Advantage operations, quality programs, Stars, care management, and value-based payment models is beneficial.

Prior people leadership or matrixed team leadership experience is preferred.

Benefits:

Remote work opportunity available nationwide.

Competitive annual compensation range of $115,200 - $158,400 USD .

Eligibility for a bonus incentive plan based on company and/or individual performance.

Comprehensive medical, dental, and vision coverage.

401(k) retirement savings plan.

Paid time off, company holidays, and personal holidays.

Paid parental and caregiver leave.

Short-term and long-term disability coverage.

Life insurance benefits.

Additional wellness and employee support programs.

Opportunity to make a meaningful impact on healthcare quality and operational performance.

How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best!  Why Apply Through Jobgether? 

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