Medicare Risk and Quality Director

Job Summary

A company is looking for a Director of Risk and Quality to lead and scale risk adjustment and Medicare quality programs.

Key Responsibilities

• Lead the enhancement and operational management of risk adjustment strategies for Medicare Advantage and other value-based models
• Design and manage HEDIS and STARs strategies in partnership with clinical teams and physician partners
• Ensure compliance with CMS guidelines and oversee relationships with external vendors for risk adjustment operations

Required Qualifications

• 8-10 years of experience managing risk adjustment programs with success across various models
• Proven experience in engaging physicians and primary care practices on documentation and coding practices
• Deep understanding of Medicare Advantage and value-based care models
• Expertise in risk adjustment coding and compliance with CMS requirements
• Bachelor's degree required; advanced degree or coding certification preferred