Job Description: Director of Risk Adjustment- Strategic Client Management: Serve as the primary operational partner for multiple external clients across medical groups, health systems, and risk-bearing entities. Serve as the trusted advisor and escalation point, lead regular performance reviews, present complex risk adjustment data, and ensure strict adherence to Service Level Agreements (SLAs).
- Team Leadership & Scalability: Directly manage a department of 70+ production coders and auditors. Lead the organizational design and hiring strategy to expand the team as the company grows into new business lines.
- Operational Excellence: Establish, monitor, and optimize department KPIs regarding coding/auditing accuracy, compliance, daily volume throughput, and turnaround times across all active risk adjustment models.
- Regulatory Alignment: Act as the internal authority on CMS-HCC coding updates, as well as future strategic expansion into commercial coding and state-specific Medicaid lines of business, ensuring all risk adjustment programs strictly adhere to current guidelines, OIG mandates, and RADV/HHS-RADV audit readiness.
- Product & Technology Collaboration: Partner cross-functionally with the Product team as the primary business stakeholder representing coding, auditing, and regulatory best practices while optimizing model performance and user experience.
QualificationsEducation: BA/BS or equivalent
Certifications:Active Certified Risk Adjustment Coder (CRC ) is highly preferred.
Certified Professional Medical Auditor (CPMA), CPC, CCS, or RHIA are considered.
Core Competencies: Exceptional operational execution across a large span of control, strong analytical data-driven decision-making, and the communication skills necessary to translate highly technical coding jargon into clear requirements for technology teams and executives.
Experience & Leadership: 9+ years of progressive experience in risk adjustment operations within a health plan, provider organization, or vendor, including 3-5 years of direct management experience over a large workforce (50+ coders and auditors).
Subject Matter Expert: Expert-level understanding of the end-to-end CMS-HCC Medicare risk coding model, including prospective, concurrent, and retrospective coding, including EDS and RAPS.
Multi-Line Coding Knowledge (Plus): A strong understanding or background in Medicaid and Commercial (ACA/Exchange) risk adjustment coding models is a plus.
Product & Technical Savvy: Proven experience collaborating with software development teams, UX designers, or engineers to build or optimize AI-enabled risk coding solutions.
Compensation and Benefits: The maximum annual salary range is $130,000 - $150,000 a year, determined by years of relevant experience, skills, and the specific geographical location where the work is performed. Pay is based on several factors, including but not limited to current market conditions, location, education, work experience, certifications, etc. IKS Health offers a competitive benefits package including healthcare, 401 (k), and paid time off (all benefits are subject to eligibility requirements for full-time employees). 
