Director, Provider Risk Adjustment

Operational Responsibilities:

• Serve as the primary strategic lead and escalation point for assigned health plan and provider clients, ensuring service quality and client satisfaction.
• Lead new client implementations including resource planning, onboarding, process mapping, and workflow design.
• Oversee contracted deliverables covering coding quality, data analysis, reporting, and productivity standards.

Leadership and Team Development:

• Manage, mentor, and develop diverse coding teams across domestic and global locations, fostering accountability and collaboration.
• Ensure coding activities follow organizational standards, policies, and regulatory requirements.
• Monitor productivity and quality KPIs, implementing performance improvement initiatives as needed.

Strategic and Process Improvement:

• Establish reporting cycles providing leadership with visibility into performance, risks, and trends.
• Identify and implement best practices to improve consistency, coding accuracy, and operational efficiency.
• Contribute to pricing models, resource forecasting, and capacity planning for sustainable program growth.

Compliance and Collaboration:

• Partner with QA, Compliance, and IT to ensure consistent delivery across programs.
• Respond proactively to client needs, resolving issues and developing sustainable solutions.
• Support continuous improvement through standardized, data-driven processes.