Director, Risk Adjustment

Job not on LinkedIn

🔥 1 minute ago

🇺🇸 United States – Remote

⏰ Full Time

🔴 Lead

🎲 Risk

👻 Ghost score 10%

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WVU Medicine

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

WVU Medicine is a comprehensive health system affiliated with West Virginia University, providing medical services through a network of hospitals across West Virginia. The system includes notable facilities such as J. W. Ruby Memorial Hospital, WVU Medicine Children's, and various other regional medical centers. WVU Medicine offers a wide range of healthcare services, including specialized and advanced medical treatments such as robotic heart surgery. It's also involved in medical education, research, and community health initiatives, emphasizing a mission of delivering high-quality care to the communities it serves.

📋 Description

• Develop and execute the enterprise risk adjustment strategy and governance framework across all applicable lines of business • Monitor regulatory changes and emerging risk adjustment methodologies, translating them into operational strategies and process improvements • Oversee accurate diagnosis capture, medical record retrieval, chart review, coding, validation, and submission of risk adjustment data • Establish and maintain coding standards, policies, procedures, and quality requirements • Oversee coding quality assurance, second-level reviews, audits, corrective action processes, coder productivity, KPIs, and compliance • Develop and deploy risk adjustment value-based programs with key providers • Develop and maintain an enterprise risk adjustment performance dashboard • Partner with actuarial and finance teams to quantify operational impact on risk scores and improve projection accuracy • Provide executive leadership with regular reporting on performance, risks, opportunities, and recommended actions • Ensure readiness for CMS RADV audits and regulatory reviews • Oversee external vendors supporting chart retrieval, coding, analytics, and other risk adjustment functions • Lead, develop, and mentor risk adjustment leaders and teams

🎯 Requirements

• Bachelor's degree in healthcare administration, business, health information management, nursing, public health, finance, or a related field • Eight (8) years of progressive experience in healthcare risk adjustment, health plan operations, coding, clinical documentation, or a related discipline • Five (5) years of leadership experience • Excellent communication, analytical, organizational, and executive leadership skills • Ability to manage multiple complex initiatives in a highly regulated and rapidly changing environment • United States of America work location/status indicated

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