Lumeris is hiring a Vice President, Risk Adjustment to provide enterprise leadership for Medicare Advantage Risk Adjustment across Essence Healthcare. In this executive role, you will develop and execute the long-term strategy to ensure accurate risk capture, disciplined compliance, and operational excellence within a highly regulated CMS environment.

What You'll Do

Define and execute a multi-year Medicare Advantage Risk Adjustment strategy aligned to enterprise growth and compliance objectives.
Strengthen governance, operational discipline, and performance visibility across the function.
Ensure full compliance with CMS Risk Adjustment methodologies, RADV requirements, and evolving regulatory guidance.
Lead enterprise preparedness for CMS audits and regulatory reviews.
Partner with medical groups and clinical leadership to drive shared accountability for accurate documentation and HCC capture.
Improve workflows that support real-time, actionable information at the point of care.
Align Risk Adjustment with Actuarial, Compliance, Product, Clinical Operations, Quality, Pharmacy, and Network teams.
Resolve cross-functional trade-offs impacting RAF performance and encounter completeness.
Establish and monitor KPIs including RAF accuracy, encounter submission completeness, provider engagement, and documentation quality.
Partner with technology and product teams to advance Risk Adjustment platforms, HCC coding tools, and encounter data workflows.
Serve as executive sponsor for Risk Adjustment technology initiatives.
Lead and develop a high-performing team through Directors and managers.
Own the Risk Adjustment budget, including staffing, vendor partnerships, and technology investments.

What We're Looking For

Bachelor’s Degree in Health Administration, Business Administration, or a related field.
15+ years of relevant experience.
7+ years of leadership experience within the healthcare sector.
7+ years of experience directly tied to Risk Adjustment and documentation and coding accuracy solutions.
Extensive experience in payer, hospital, Medicaid/Medicare, provider environment, or managed care settings.
Proven ability to influence and lead cross-functional teams in a complex, matrixed environment.
In-depth knowledge of Risk Adjustment Payment methodologies and the CMS HCC Model.
Strong organizational, analytical, and communication skills.
Demonstrated commitment to best practices, continuous process improvement, and effective change management.
Ability to travel up to 50%.

Nice to Have

Experience in Commercial Risk Adjustment.
Experience with ACO REACH Risk Adjustment.
Coding Certification (e.g., CPC or CRC).
Master’s Degree in a related field.

Team & Environment

You will lead the Risk Adjustment organization through Directors and senior leaders.

Benefits & Compensation

Compensation: $175,300.00-$249,100.00 + equity; eligibility depending on the position.
Medical, Vision and Dental Plans.
Tax-Advantage Savings Accounts (FSA & HSA).
Life Insurance and Disability Insurance.
Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days).
Employee Assistance Program.
401k with company match.
Employee Resource Groups.
Employee Discount Program.
Learning and Development Opportunities.