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.
Work Mode
This is a remote position open to candidates anywhere in the USA.
Lumeris is an EEO/AA employer M/F/V/D.
