Lead, Organic Risk Adjustment

Humana

Lead Organic Risk Adjustment program development and execution at Humana. Analyzing data and improving healthcare documentation accuracy and performance.

Posted 7/30/2026full-timeRemote • 🇺🇸 United StatesSenior💰 $115,200 - $158,400 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Medicare Advantage risk adjustment, clinical documentation improvement, and coding strategies, while effectively managing cross-functional initiatives and stakeholder engagement in a fast-paced healthcare environment.

Highest-signal resume keywords

Medicare Advantage Risk AdjustmentClinical Documentation ImprovementData Analysis and Insights TranslationProvider Education DevelopmentStakeholder Management

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Risk Adjustment PerformanceWorkflow DevelopmentAction Plan ImplementationQuality ImprovementCoding Strategies

Soft Skills

Strong CommunicationFacilitation SkillsAccountability TrackingMulti-Priority Management

Certifications & Qualifications

Bachelor’s Degree or Equivalent Experience

Industry Keywords

Value-Based Care OperationsClinical WorkflowsProvider EngagementHealthcare EnvironmentRegulatory Compliance

About the role

Key responsibilities & impact

Build and operationalize programs that improve organic risk adjustment performance
Develop workflows, playbooks, provider engagement approaches, and reporting processes from the ground up
Identify opportunities, create action plans, and personally drive implementation through completion
Manage multiple initiatives simultaneously, ensuring deliverables are completed on time and produce measurable results
Serve as the point person for day-to-day execution of Organic Risk Adjustment initiatives
Partner directly with providers, practice leaders, operations teams, and clinical stakeholders to improve documentation and coding performance
Create practical solutions that fit within existing clinical workflows
Lead meetings, track action items, and ensure accountability across stakeholders
Analyze data to identify documentation and risk capture opportunities
Translate insights into operational actions and measurable performance improvement
Monitor outcomes and adjust programs based on results.

Requirements

What you’ll need

Bachelor’s degree or equivalent experience
6+ years of related lead level experience
Experience in Medicare Advantage risk adjustment, RAF performance, clinical documentation improvement, coding, quality, or value-based care operations
Demonstrated ability to lead cross-functional initiatives involving clinical, coding, analytics, quality, and operational stakeholders
Experience developing provider education, documentation improvement strategies, and performance feedback processes
Ability to analyze data trends, identify root causes, and translate insights into operational action plans
Strong communication, facilitation, and stakeholder management skills
Ability to manage multiple priorities in a fast-paced, highly regulated healthcare environment.

Benefits

Comp & perks

medical, dental and vision benefits
401(k) retirement savings plan
time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
short-term and long-term disability
life insurance and many other opportunities