Lead, Organic Risk Adjustment

**This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Lead, Organic Risk Adjustment based in the United States.**

This role offers the opportunity to build and scale programs that improve healthcare outcomes through stronger documentation accuracy and risk adjustment performance.

You will serve as a hands-on leader responsible for turning ideas into operational programs, developing workflows, and driving measurable improvements.

The position combines analytics, provider engagement, process design, and cross-functional collaboration within a highly regulated healthcare environment.

You will partner with clinical, operational, and analytical teams to identify opportunities and implement sustainable solutions.

The ideal candidate is a proactive builder who thrives on execution, problem-solving, and creating processes that deliver meaningful impact.

This remote opportunity is suited for someone who enjoys owning complex initiatives and improving healthcare operations through data-driven strategies.

### Accountabilities

The Lead, Organic Risk Adjustment will be responsible for designing, launching, and improving programs that enhance documentation quality, risk capture, and overall operational performance. This role requires a combination of strategic thinking and hands-on execution, with a focus on building scalable processes and driving collaboration across healthcare teams.

• Build and operationalize organic risk adjustment programs designed to improve performance and documentation accuracy.
• Develop workflows, playbooks, provider engagement strategies, and reporting processes from initial design through implementation.
• Identify improvement opportunities, create action plans, and drive initiatives to successful completion.
• Manage multiple projects simultaneously while ensuring timelines, objectives, and performance goals are achieved.
• Serve as the operational owner for day-to-day execution of risk adjustment initiatives.
• Partner with providers, practice leaders, clinical teams, and operational stakeholders to improve documentation and coding outcomes.
• Create practical solutions that integrate effectively into existing clinical workflows.
• Lead stakeholder meetings, coordinate action items, and maintain accountability across teams.
• Analyze healthcare data to identify documentation gaps, risk capture opportunities, and performance trends.
• Translate analytical insights into actionable improvement plans and measurable operational outcomes.
• Monitor program results, evaluate effectiveness, and adjust approaches based on performance data.

## Requirements

The ideal candidate brings extensive experience in healthcare operations, risk adjustment, and cross-functional program leadership. Success in this role requires strong analytical abilities, excellent stakeholder management skills, and the ability to execute initiatives in a complex healthcare environment.

• Bachelor’s degree or equivalent professional experience.
• 6+ years of related lead-level experience in healthcare operations, risk adjustment, clinical documentation improvement, coding, quality, or value-based care.
• Experience with Medicare Advantage risk adjustment programs and RAF performance improvement.
• Proven ability to lead cross-functional initiatives involving clinical, coding, analytics, quality, and operational teams.
• Experience developing provider education programs, documentation improvement strategies, and performance feedback processes.
• Strong analytical skills with the ability to identify trends, uncover root causes, and translate insights into action plans.
• Excellent communication, facilitation, and stakeholder management abilities.
• Ability to manage multiple priorities and deliver results in a fast-paced, highly regulated environment.
• Experience with organic or prospective risk adjustment programs is preferred.
• Familiarity with provider-facing documentation workflows, EMR-based interventions, suspect condition programs, or point-of-care gap closure strategies is a plus.
• Experience creating dashboards, executive reporting, or performance scorecards is preferred.
• Knowledge of Medicare Advantage operations, quality programs, Stars, care management, and value-based payment models is beneficial.
• Prior people leadership or matrixed team leadership experience is preferred.

## Benefits

• Remote work opportunity available nationwide.
• Competitive annual compensation range of **$115,200 - $158,400 USD**.
• Eligibility for a bonus incentive plan based on company and/or individual performance.
• Comprehensive medical, dental, and vision coverage.
• 401(k) retirement savings plan.
• Paid time off, company holidays, and personal holidays.
• Paid parental and caregiver leave.
• Short-term and long-term disability coverage.
• Life insurance benefits.
• Additional wellness and employee support programs.
• Opportunity to make a meaningful impact on healthcare quality and operational performance.