You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Job Summary

Our client is seeking a skilled Risk Adjustment Director to serve as the executive strategic leader and subject matter expert for the health plan's Risk Adjustment Department. The primary responsibilities include designing and overseeing data strategies to ensure accurate member health coding, managing financial impacts of risk scores, leading a team, and acting on behalf of the CFO when necessary.

Responsibilities / Job Duties

• Build the roadmap for the health plan's risk adjustment goals to improve data collection, reporting, and auditing.
• Track risk scores and work closely with Actuaries and Financial Planning & Analysis to align with budgets.
• Optimize Risk Adjustment Factor improvements through external vendors.
• Partner with the Provider Relations Director to train and support doctors on compliant, accurate medical record coding.
• Hire, train, mentor, and evaluate a team of risk adjustment professionals.
• Formulate and manage the Risk Adjustment Department’s operational budget.
• Oversee Medicare DSNP Risk Adjustment strategy and execution.
• Directly support key operational initiatives to ensure program stability and scalability.

Minimum Education and Experience Qualification Requirements

Education

• Bachelor’s degree in Finance, Business, Healthcare Administration, Mathematics, Statistics, or a closely related field.

Qualifications

• 10 years of experience in healthcare finance or analytics.
• 5 years of experience with Medicare risk adjustment processes.
• 2 years of experience related to Medicare Managed Care Programs.
• 3 years of supervisory experience.
• Expert knowledge of Medicare HCC risk adjustment models.
• Working knowledge of CPT, HCPCS, and ICD-9/10 medical coding.
• Familiarity with data analytical tools like SQL and visualization platforms like Tableau.

Skills

• Technical proficiency in data analytical tools and coding methodologies.
• Strong leadership and team management skills.
• Excellent communication and organizational abilities.

Schedule / Shift

Mon-Fri 8am-5pm (potential for some flexibility for early/later start upon discussion)

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

Required Employment / Compliance Language

Medix is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex

^*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

Medix Overview:

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.

^*As a job position within our Insurance division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing medical and confidential records, verifying financial information, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients