Director, Provider Risk Adjustment

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Virtix Health

WebsiteLinkedInAll Job Openings

11 - 50 employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance • Technology

Virtix Health is a company that partners with health plans across the country to enhance clinical, financial, and operational outcomes. They offer a variety of services, including virtual wellness visits, in-home health risk assessments, retrospective chart review, workflow technology, and patient engagement services. They specialize in risk adjustment coding and clinical data connectivity, providing technology solutions that automate data acquisition and improve the management of medical records. Their aim is to innovate how healthcare data is exchanged to elevate the performance of health plans of all sizes.

📋 Description

• Serve as the primary escalation point and strategic lead for assigned clients • Oversee successful implementation of new clients, including resource planning, onboarding, process mapping, and EMR/project education • Maintain accountability for contracted deliverables, including coding quality, project guidelines, data analysis and reporting, and production standards • Lead regular client meetings and updates and provide proactive issue resolution • Manage and mentor coding professionals across domestic and global locations • Ensure compliance with organizational coding standards, policies, and procedures • Monitor productivity and quality metrics and implement performance improvement plans as needed • Partner with QA, Compliance, IT, and other internal stakeholders for seamless service delivery • Lead standing meetings and reporting cycles covering KPIs, risks, and mitigation plans • Identify and implement best practices across teams • Evaluate workflows and recommend enhancements for efficiency, accuracy, and scalability • Support development and implementation of coding tools, technologies, and reporting dashboards • Collaborate on pricing models and forecasting for resourcing and capacity planning

🎯 Requirements

• Bachelor’s degree in Health Information Management, Health Administration, Finance, or related field required; Master’s preferred • 10+ years of progressive experience in medical coding or value-based care operations • 5+ years in a leadership capacity • Proven experience in payer-side operations and risk-based programs • Strong understanding of HCC coding practices, coding quality, and regulatory guidelines • Demonstrated ability to manage global teams and vendor relationships • Excellent organizational, analytical, and communication skills • Proficiency in MS Office and data analysis/reporting tools • Preferred 5–7 years’ experience in value-based care organizations with risk adjustment programs • Strong understanding of payer contracting, reimbursement, and programmatic structure, policies, and procedures • Experience with telecommuting and electronic medical record systems highly preferred • Ability to work with multiple and diverse clients and projects • Ability to work with minimal supervision • Ability to supervise and counsel staff to promote development and company success • Ability to solve problems, collect data, establish facts, and draw valid conclusions • Ability to interpret technical instructions and manage abstract and concrete variables • Thorough knowledge of HCC coding documentation requirements for complete and accurate coding • Data quality and integrity skills • Knowledge of word processing, spreadsheet, and database software • English required for verbal and written communication • RHIA, RHIT, or CCS certification preferred • Experience in a global revenue cycle management company preferred • Familiarity with payer reimbursement models and audit functions preferred • Strong project and change management skills preferred

🏖️ Benefits

• Competitive annual salary • Medical/Dental/Vision Insurance • Equipment provided • 401k matching program • FTO: Flex Unlimited Annual PTO • Paid Paternity & Maternity leave programs • 9 paid annual holidays • Life Insurance • Long term disability • Short term disability options • Tuition reimbursement