Director, Risk Adjustment & Performance - Remote

Overview

The Director, Risk Adjustment & Performance at Harbor Health is responsible for driving process improvements and system enhancements in healthcare data management, ensuring compliance with regulatory requirements, and optimizing encounter submission performance across multiple markets.

In Short

• Monitor team performance and project production.
• Collaborate with multiple teams to improve operations.
• Create and conduct risk adjustment training.
• Manage risk adjustment project volumes.
• Evaluate medical records for coding accuracy.
• Review project performance and escalate issues.
• Ensure compliance with State and Federal regulations.
• Support coding and auditing teams.
• Deliver provider audit results with education.
• Maximize health plan reimbursement.

Requirements

• Bachelor's degree or relevant work experience.
• 5+ years in Risk Adjustment Coding and Auditing.
• 2+ years managing teams.
• 4+ years as a subject matter expert in ACA Risk Adjustment.
• 2+ years with EHRs and CCDs.
• Certified Professional Coder (CPC) certification.
• 3+ years leading Risk/Encounter submission processes.
• Experience in developing business metrics and dashboards.
• Familiarity with Texas Department of Insurance regulations preferred.
• Strong Excel and PowerPoint skills.

Benefits

• Opportunity to mentor and develop individuals.
• Collaborative and dynamic work environment.
• Passionate team focused on changing healthcare.
• Competitive salary and benefits package.
• Professional development opportunities.
• Transparent and unique culture.