Medical Director, Risk Adjustment – Los Angeles, CA
2 weeks ago
Medical Director, Risk Adjustment – Los Angeles, CA (Hybrid)
Compensation: $200,000 – $280,000 per year + Bonus
Schedule: Full-Time | Hybrid (Onsite & Remote)
Overview:
We're seeking a Medical Director, Risk Adjustment to lead and advance our clinical risk adjustment strategy. This physician leader will play a key role in ensuring accurate documentation of patient complexity and chronic conditions while maintaining full compliance with CMS requirements and supporting overall revenue integrity.
This is an exceptional opportunity for a seasoned physician who thrives at the intersection of clinical excellence, data-driven decision-making, and value-based care.
Key Responsibilities:
Clinical Leadership
- Provide physician leadership in risk adjustment strategy and accurate capture of patient complexity.
- Collaborate with senior leadership to establish goals and monitor outcomes tied to risk adjustment and revenue integrity.
Provider Engagement & Education
- Develop and deliver education programs for physicians, APPs, and clinical staff focused on documentation integrity and coding accuracy.
- Act as a trusted advisor and subject matter expert on HCC coding and best practices.
- Champion prospective risk capture at the point of care.
Data & Performance Improvement
- Review documentation, coding, and quality data to identify opportunities for improvement at the provider and market levels.
- Lead targeted interventions to enhance RAF accuracy, reduce audit risk, and improve compliance.
- Partner with analytics teams to develop dashboards and performance tracking tools.
Cross-Functional Collaboration
- Work closely with coding, compliance, analytics, and operations teams to align risk adjustment with broader organizational goals.
- Support initiatives that advance quality, value-based care, and financial performance.
Compliance & Audit Readiness
- Ensure adherence to CMS and OIG regulations, including RADV requirements.
- Maintain audit-ready documentation and proactively adapt to regulatory changes to protect revenue integrity.
Qualifications:
- MD or DO with active, unrestricted medical license (required)
- Board Certification in Internal Medicine, Family Medicine, or related specialty (preferred)
- 8+ years of clinical practice experience, with 3–5 years focused on risk adjustment, CDI, or value-based care
- Proven success leading provider education and engagement programs
- Strong understanding of Medicare Advantage and CMS risk adjustment methodology (HCC coding, RAF scoring, RADV audits)
Why Join Us:
- Competitive compensation and bonus structure
- Hybrid work flexibility (Los Angeles, CA area)
- Mission-driven organization focused on improving outcomes through value-based care
- Collaborative, innovative environment
For more information contact:
PL #PM-
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