AVP, Medicare Risk Adjustment Performance

🕒 September 4

🇺🇸 United States – Remote

💵 $198.2k - $297.3k / year

⏰ Full Time

🔴 Lead

🎲 Risk

👻 Ghost score 16%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Alignment Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2013

⚕️ Healthcare Insurance

🛡️ Insurance

🏥 Healthcare

💰 $135M Series C on 2020-03

Healthcare Insurance • Insurance • Healthcare

Alignment Health is dedicated to providing comprehensive care for Medicare members, emphasizing the needs of seniors, the chronically ill, and those who are frail. With a mission to transform senior healthcare, Alignment Health leverages a tailored care model and advanced technology to deliver high-quality, low-cost healthcare services. Their 24/7 concierge care team collaborates with trusted local providers to ensure that every member receives personalized care, reflecting the company's commitment to treating all members as valued family members.

📋 Description

• Provide executive leadership for Alignment Health’s enterprise Medicare Risk Adjustment performance strategy and operations • Own annual RAF performance objectives and Risk Adjustment targets • Lead prospective, concurrent and retrospective Risk Adjustment strategies and execution • Oversee provider engagement, coding operations, chart retrieval, submission, analytics, vendor management and revenue realization • Partner with Market Operations, Network Management, Clinical Operations, Finance, Compliance, and Data & Technology teams • Lead the annual operating plan, including goals, measures, milestones, resources and market-level execution plans • Establish performance guidelines for quality, productivity, service levels and financial outcomes • Use analytics and strategic business analysis to identify opportunities, risks, root causes and interventions • Partner with Finance and Actuarial teams on RAF forecasting, revenue implications, bid development and long-range planning • Establish strategic direction and performance expectations for Risk Adjustment vendors and external partners • Serve as executive sponsor for provider coding performance and documentation improvement initiatives • Develop scalable reporting, analytical and operational capabilities supporting visibility, audit readiness and reduced manual controls • Define business requirements for workflow modernization, automation, provider enablement and enterprise reporting • Sponsor technology initiatives improving scalability, productivity, transparency and audit readiness • Support RADV readiness, validation findings, reconciliation, diagnosis corrections and audit remediation • Establish policies, procedures, standard work and governance routines for accurate and compliant execution • Maintain knowledge of CMS risk adjustment requirements, model changes and regulatory guidance • Build, mentor and retain a high-performing multidisciplinary team • Develop multi-year strategies, annual goals, KPIs and resource requirements • Lead business cases for Risk Adjustment investments, operational initiatives and technology capabilities • Oversee assigned leaders and staff, including workforce planning, recruiting, training, goal setting, performance management and coaching

🎯 Requirements

• Ten or more years of progressive experience in managed care, Medicare Advantage, healthcare analytics, healthcare finance, risk adjustment, population health or related operations • Experience leading enterprise Risk Adjustment programs across multiple markets and provider arrangements • Demonstrated responsibility for financial performance, forecasting, strategic planning, or major business initiatives • Proven track record managing executive stakeholders and enterprise-wide programs • Seven or more years of people leadership, including development of high-performing analytical or operational teams • Bachelor’s degree in healthcare, business, finance, analytics, information systems or a related field, or equivalent relevant experience • Demonstrated knowledge of CMS-HCC risk adjustment methodology, Medicare Advantage reimbursement, coding and documentation programs, encounter data, and performance measurement • Demonstrated experience designing or leading analytics, reporting, data governance or scalable data infrastructure that supports reporting accuracy, regulatory compliance and audit readiness • Experience leading complex cross-functional initiatives and working with executives, providers, vendors, compliance partners and technical teams • Experience with risk adjustment forecasting, provider performance analytics, data warehousing, SQL-based analytics or business intelligence platforms • Experience supporting multiple government-program lines of business or large, multi-market Medicare Advantage operations • Advanced ability to translate complex data into executive-level insights, recommendations and action plans • Strong verbal, written, presentation, organization and relationship-management skills • Must be efficient in Excel; SQL knowledge preferred • Good organization, analytical, interpersonal and communication skills

🏖️ Benefits

• Equal Opportunity/Affirmative Action Employer