Director of Risk Adjustment and Quality
2 weeks ago
Director of Risk Adjustment and Quality Department: Risk Adjustment & Quality Product Operations Reports to: VP of Product Position Summary The Director of Risk Adjustment and Quality leads the strategy, execution, and optimization of risk adjustment and quality initiatives for our SaaS platform serving Medicare Advantage, provider organizations, and payer markets. This role ensures our platform delivers accurate risk scoring, quality measure tracking, and regulatory compliance while supporting clients’ value-based care and financial performance goals. Key Responsibilities Own the risk adjustment and quality product roadmap for Medicare Advantage, provider organizations, and commercial payer clients. Lead the development of HCC coding, suspecting, recapture tracking, and gap closure modules within the platform. Oversee analytics, reporting, and client enablement programs focused on risk adjustment accuracy and quality measure performance (HEDIS, STAR Ratings, CAHPS, etc.). Ensure compliance with CMS guidelines, NCQA standards, and other regulatory requirements specific to Medicare Advantage and commercial risk programs. Partner with Product, Engineering, and Data Science teams to deliver scalable, high‑performing SaaS solutions supporting MA plans, provider groups, and health plans. Work directly with client leadership teams to translate regulatory and business requirements into actionable platform configurations and reporting strategies. Provide subject matter expertise on CMS file formats (BCDA, CCLF, EDGE) and value‑based care models including ACO REACH, MSSP, and commercial risk arrangements. Lead internal teams including clinical coders, quality analysts, and client success staff focused on risk and quality performance improvement. Analyze and report on key KPIs including RAF score accuracy, gap closure rates, and STAR metric performance, driving continuous improvement strategies. Monitor industry trends, regulatory updates, and competitor activity to inform product and business strategy. Qualifications Bachelor’s degree in Healthcare Administration, Public Health, Data Science, or a related field; Master’s preferred. 8+ years of experience in Medicare Advantage, risk adjustment, and quality improvement within a payer, provider, or SaaS environment. Proven leadership experience overseeing risk adjustment and quality programs, including team management and cross‑functional collaboration. Deep understanding of Medicare Advantage program requirements, including HCC coding, STAR ratings, HEDIS measures, CAHPS, and VBP models. Experience with payer‑provider collaboration and managing risk programs across different organizational structures. Familiarity with healthcare data formats: FHIR, HL7, BCDA, CCLF, EDGE files, and claims data. Exceptional communication, client‑facing, and presentation skills. Preferred Skills Certified Risk Adjustment Coder (CRC) or Certified Professional Coder (CPC). Experience deploying AI or machine learning solutions for risk adjustment or quality gap closure. Strong understanding of data integration workflows supporting payers, providers, and Medicare Advantage plans. #J-18808-Ljbffr
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Director of Risk Adjustment and Quality
3 weeks ago
Dallas, United States CareSignal® – Lightbeam's Deviceless Remote Patient Monitoring Full timeJob Title: Director of Risk Adjustment and Quality Department: Risk Adjustment & Quality Product Operations Reports to: VP of Product Position Summary The Director of Risk Adjustment and Quality leads the strategy, execution, and optimization of risk adjustment and quality initiatives for our SaaS platform serving Medicare Advantage, provider organizations,...
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Director of Risk Adjustment and Quality
2 weeks ago
Dallas, United States CareSignal® – Lightbeam's Deviceless Remote Patient Monitoring Full timeOverviewJob Title: Director of Risk Adjustment and QualityDepartment: Risk Adjustment & Quality Product OperationsReports to: VP of ProductPosition Summary The Director of Risk Adjustment and Quality leads the strategy, execution, and optimization of risk adjustment and quality initiatives for our SaaS platform serving Medicare Advantage, provider...
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Director of Risk Adjustment and Quality
3 weeks ago
Dallas, United States CareSignal® – Lightbeam's Deviceless Remote Patient Monitoring Full timePosition Summary The Director of Risk Adjustment and Quality leads the strategy, execution, and optimization of risk adjustment and quality initiatives for our SaaS platform serving Medicare Advantage, provider organizations, and payer markets. This role ensures our platform delivers accurate risk scoring, quality measure tracking, and regulatory compliance...
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Director, Risk Adjustment
3 weeks ago
Dallas, United States CareSignal® – Lightbeam's Deviceless Remote Patient Monitoring Full timeA healthcare technology company is seeking a Director of Risk Adjustment and Quality to lead the strategy and execution of risk adjustment initiatives for their SaaS platform. This position requires a minimum of 8 years of experience in Medicare Advantage and a deep understanding of risk adjustment and quality improvement programs. The role involves managing...
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Director, Risk Adjustment
3 weeks ago
Dallas, United States CareSignal® – Lightbeam's Deviceless Remote Patient Monitoring Full timeA leading healthcare technology company is seeking a Director of Risk Adjustment and Quality in Dallas, Texas. This role will lead the strategy for risk adjustment initiatives, ensuring compliance with regulations while enhancing quality measures for the SaaS platform. The ideal candidate has over 8 years of experience in Medicare Advantage, exceptional...
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Director of Risk Adjustment
2 weeks ago
Dallas, United States CareSignal® – Lightbeam's Deviceless Remote Patient Monitoring Full timeA healthcare technology company in Dallas is looking for a Director of Risk Adjustment and Quality to lead the strategy and execution of quality initiatives for their SaaS platform in Medicare Advantage. The ideal candidate will have extensive experience in risk adjustment, compliance, and product management. Strong leadership and communication skills are...
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Director of Risk Adjustment
2 weeks ago
Dallas, United States CareSignal® – Lightbeam's Deviceless Remote Patient Monitoring Full timeA leading healthcare technology organization is seeking a Director of Risk Adjustment and Quality to lead the strategy and execution of risk adjustment initiatives for their SaaS platform. The ideal candidate will have 8+ years of experience in Medicare Advantage, strong leadership skills, and a deep understanding of regulatory compliance. This role offers a...
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Senior Director, Medicare Risk Adjustment
3 weeks ago
Dallas, United States CareSignal® – Lightbeam's Deviceless Remote Patient Monitoring Full timeA leading healthcare technology company is seeking a Director of Risk Adjustment and Quality to lead strategies for risk and quality initiatives for Medicare Advantage. The role requires 8+ years of relevant experience and involves managing cross-functional teams, ensuring compliance, and driving improvements in risk adjustment and quality performance. This...
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Risk Adjustment Validation Audit Manager
3 weeks ago
Dallas, United States Texas Staffing Full timeRisk Adjustment Validation Audit ManagerOptum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a...
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Risk Adjustment Validation Audit Manager
2 weeks ago
Dallas, United States Dallas Staffing Full timeRisk Adjustment Validation Audit ManagerOptum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a...
