Assistant Vice President, Risk Adjustment
E-Verify Program
full-time
Posted on:
Location Type: Hybrid
Location: Kentucky • Texas • United States
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Salary
💰 $210,268 - $336,430 per year
Job Level
About the 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.
Requirements
- 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.
Benefits
- Competitive compensation, incentive opportunity, and comprehensive benefits
- 401(k) with employer match
- Paid Time Off (PTO)
- Health benefits and wellness programs
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Risk Adjustment strategyMedicare Advantage Risk AdjustmentACA Marketplace Risk AdjustmentCMS HCC Risk Adjustment modelsHHS Risk Adjustment modelsRADV auditsICD-10-CM coding guidelinesdocumentation standards
Soft Skills
leadershipmentoringaccountabilityinnovationcontinuous learninganalytical skillsfinancial skillscommunication skills
Certifications
Bachelor's degreeMaster's degree (MBA, MPH, MHA or similar)