The Vice President, Physician Documentation & Value Performance, CDO (Care Delivery Organization) is accountable for the strategy, execution, and optimization of all Risk Adjustment programs across the Care Delivery Organization's Medicare Advantage business owning the day today performance of the function for the CDO. This executive partners closely with Clinical, Quality, Analytics, Finance, Provider Relations, and Member Experience teams to build and execute a unified Risk Adjustment strategy that maximizes revenue accuracy, ensures CMS compliance, and demonstrates the true complexity of the members the organization serves. Leading a dedicated team, the VP translates federal regulatory requirements, market intelligence, and data driven insights into action
enabling provider engagement, refining coding and documentation practices, and achieving measurable improvement across HCC accuracy and program performance. This role is critical to the organization because Risk Adjustment is a primary driver of Medicare Advantage revenue integrity and the VP's ability to align a physician's clinical, operational, and analytical functions around a shared performance agenda directly determines the organization's financial position and long-term competitiveness in the MA market.

Job Responsibilities:

Develop and Execute the Multi-Year Risk Adjustment Business Plan. Building and executing a multi-year business plan that analyzes the interrelationships of products, operations, market dynamics, and program performance to achieve sustained improvement in RAF accuracy and revenue optimization for the Care Delivery Organization. Establish, track, and drive performance targets and KPIs across all Risk Adjustment programs, ensuring the organization moves from reactive compliance to proactive, forward-looking performance management.

Lead Provider Network Engagement for Risk Adjustment Performance. Design and execute direct physician engagement strategies that improve HCC coding accuracy, clinical documentation quality, and Risk Adjustment performance. Build structured, trust based relationships with physician partners educating on coding standards, identifying gaps, and creating feedback loops that make documentation improvement sustainable and clinically meaningful rather than administratively burdensome.

Build, Lead, and Develop the Risk Adjustment Team. Direct and develop a high performing team setting clear performance expectations, fostering a culture of accountability and continuous improvement, and investing in the professional growth of every team member. Ensure the team has the tools, training, market data, and operational infrastructure needed to execute the Risk Adjustment strategy at scale across all markets.

Maintain Expert Regulatory and Competitive Intelligence. Serve as the Care Delivery Organization's foremost authority on CMS regulations, federal legislative changes, industry trends, and best practices in Medicare Risk Adjustment providing timely, accurate, and actionable intelligence that enables the organization to stay ahead of regulatory shifts and competitive threats. Analyze and communicate the business implications of policy changes and market dynamics to senior leadership, providing recommendations that protect and optimize the organization's Risk Adjustment posture.

Leverage Data and Analytics to Drive Performance Improvement. Partner with Analytics, Finance, and IT teams to build and maintain the data infrastructure, reporting tools, and analytical capabilities required to identify Risk Adjustment opportunities, measure program effectiveness, and inform strategic decisions at every level of the organization. Ensure Risk Adjustment performance reporting is timely, accurate, and decision-grade and that insights translate into operational action across clinical, coding, and provider-facing programs.

Oversee Risk Adjustment Accuracy, Audit Readiness, and Compliance. Managing coding audits, retrospective and prospective review processes, and vendor management for external coding and audit partners. Ensure the organization maintains a state of continuous CMS audit readiness, proactively identifies and corrects coding inaccuracies, and operates all Risk Adjustment activities in strict compliance with CMS guidelines and organizational standards

Other duties and projects not listed above

Supervisory Responsibilities:

• Directly supervises management-level staff and provides oversight across the broader team through those managers under the CDO.
• Responsible for building and sustaining a high performance team culture, including talent acquisition, onboarding, performance management, development planning, and retention for all direct and indirect reports
• Oversees assigned staff. Responsibilities include: recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and performance management.

Experience:

Required:

• Minimum 15 years of progressive leadership experience in Medicare Advantage, with significant depth in Risk Adjustment and or Stars including direct accountability for program strategy, team leadership, and measurable performance outcomes
• Demonstrated experience developing and executing multi-year Risk Adjustment business plans in a health plan, managed care organization, or related Medicare Advantage entity
• Deep working knowledge of HCC coding, CMS Risk Adjustment data validation (RADV) processes, prospective and retrospective coding programs, and the regulatory requirements governing Medicare Risk Adjustment
• Proven track record of leading provider engagement strategies that produce measurable improvements in coding accuracy and documentation quality at scale
• Demonstrated experience in a highly matrixed, cross functional environment leading through influence as well as authority to drive aligned execution across clinical, operational, finance, and analytics teams

Preferred:

• Prior VP or above-level experience in a Medicare Advantage health plan not just consulting or vendor engagement
• Experience leading through CMS RADV audits or federal regulatory review processes
• Background in Medicare Part D program operations and the intersection of Part D and Risk Adjustment performance
• Track record of integrating Stars, HEDIS, and Risk Adjustment programs into a unified performance model

Education:

Required:

Bachelor's degree in Healthcare Administration, Business Administration, Finance, Public Health, or a related field; equivalent combination of education and leadership experience in Medicare Risk Adjustment will be considered

Preferred:

Master's degree (MBA, MHA, MPH, or related graduate degree) particularly with coursework or concentration in healthcare finance, managed care, or health policy

Training:

Required:

Demonstrated expert level knowledge of CMS Medicare Risk Adjustment methodology, HCC coding frameworks, and RADV audit processes through formal training, professional certification, or extensive applied experience

Preferred:

CRC (Certified Risk Adjustment Coder) or CPC (Certified Professional Coder) certification

Lean, Six Sigma, or other structured performance improvement methodology

Formal executive leadership development or continuing education aligned to Medicare policy and managed care strategy

Preferred:

CRC (Certified Risk Adjustment Coder)

CPC (Certified Professional Coder)

PAHM (Professional, Academy for Healthcare Management) or equivalent managed care certification

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Pay Range: $227,952.00 - $341,928.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.