Assistant Vice President, Risk Adjustment

E-Verify Program

Assistant Vice President (AVP) of Risk Adjustment leading strategies across Medicare Advantage and ACA Marketplace for Blue Cross NC. Responsible for Risk Adjustment programs ensuring revenue and regulatory compliance.

Posted 4/16/2026full-timeKentucky, Texas, Wisconsin • 🇺🇸 United StatesLead💰 $210,268 - $336,430 per yearWebsite

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

Competitive compensation, incentive opportunity, and comprehensive benefits
401(k) with employer match
Paid Time Off (PTO)
Health benefits and wellness programs

ATS Keywords

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Applicant Tracking System Keywords

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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)