Verda Healthcare, Inc. is a Medicare Advantage Prescriptions Drug Plan (MAPD) organization committed to the idea that healthcare should be easily and equitably accessed by all, currently available in Texas and Arizona. Our mission is to ensure that underserved communities have access to health and wellness services, and receive the support needed to live a healthy life that is free of worry and full of joy. We are looking for a Director, Risk Adjustment to join our growing company with many internal opportunities.
Are you ready to join a company that is changing the face of health care across the nation? Verda Healthcare health plan is looking for people like you who value excellence, integrity, care and innovation. As an employee, you’ll join a team dedicated to improving the lives of our Medicare members. Our vision incorporates value-based health care that works. We value diversity.
Align your career goals with Verda Healthcare, Inc. and we will support you all the way.
Position Overview This Director, Risk Adjustment oversees the strategy, operations, and compliance of Hierarchical Condition Category (HCC) programs, aiming to ensure accurate, timely data submission, optimize revenue, and maintain CMS regulatory compliance. This leadership role typically requires 5–13+ years of experience in risk adjustment, coding, or analytics, leading cross-functional teams to improve documentation and audit performance. Drive direct efforts to strengthen and maintain RAF scores by implementing scalable process improvements and evolving departmental strategy.
This position reports to the Chief Executive Officer in the interim.
Responsibilities:
Verda cares deeply about the future, growth, and well-being of its employees. Join our team today!
Job Type: Full-time employment
Compensation Range: $130,000 – $160,000 annually
Actual compensation offered will be determined based on experience, qualifications, skills, internal equity (if available), and geographic location. This position may also be eligible for performance-based incentive compensation and benefits.
Benefits:
Schedule:
Ability to commute/relocate:
PHYSICAL DEMANDS Regularly sit/walk at a workstation in an office or cubicle setting. Must occasionally lift and/or move up to 25-50 pounds.
*Other duties may be assigned in support of departmental goals.
Are you ready to join a company that is changing the face of health care across the nation? Verda Healthcare health plan is looking for people like you who value excellence, integrity, care and innovation. As an employee, you’ll join a team dedicated to improving the lives of our Medicare members. Our vision incorporates value-based health care that works. We value diversity.
Align your career goals with Verda Healthcare, Inc. and we will support you all the way.
Position Overview This Director, Risk Adjustment oversees the strategy, operations, and compliance of Hierarchical Condition Category (HCC) programs, aiming to ensure accurate, timely data submission, optimize revenue, and maintain CMS regulatory compliance. This leadership role typically requires 5–13+ years of experience in risk adjustment, coding, or analytics, leading cross-functional teams to improve documentation and audit performance. Drive direct efforts to strengthen and maintain RAF scores by implementing scalable process improvements and evolving departmental strategy.
This position reports to the Chief Executive Officer in the interim.
Responsibilities:
- Strategy Development: Design and implement comprehensive Medicare Advantage risk adjustment strategies to optimize revenue while ensuring compliance with CMS regulations. Build and implement Risk Adjustment program enterprise wide. Lead initiatives to optimize and sustain RAF performance while driving continuous improvement across operational processes and departmental strategy.
- Operations Oversight: Manage risk adjustment data capture, coding, and submission processes, including vendor management for medical record reviews.
- Provider Engagement: Educate providers and office staff on documentation accuracy to ensure complete, compliant, and timely documentation of patient health status.
- Compliance & Audit Management: Lead Medicare Advantage Risk Adjustment Data Validation (RADV) audits and monitor for regulatory changes, identifying risks and improving coding accuracy.
- Analytics & Reporting: Perform root cause analysis on coding and data, providing actionable insights to leadership and clinical teams.
- Experience: 5-10+ years of experience in healthcare risk adjustment, specifically with Medicare Advantage programs.
- Leadership: 5-7+ years of experience in a senior leadership role with proven strategy, direction, end-to-end program development and implementation.
- Education: Bachelor’s degree in healthcare administration, business, or a related field; Master’s preferred.
- Certifications: Coding certification (CPC, CCS, or RHIT) is often required or preferred.
- Skills: Expertise in CMS-HCC models, medical coding, and proficiency in data analysis tools (e.g., SQL, Excel).
Verda cares deeply about the future, growth, and well-being of its employees. Join our team today!
Job Type: Full-time employment
Compensation Range: $130,000 – $160,000 annually
Actual compensation offered will be determined based on experience, qualifications, skills, internal equity (if available), and geographic location. This position may also be eligible for performance-based incentive compensation and benefits.
Benefits:
- 401(k)
- Paid time off (vacation, holiday, sick leave)
- Health insurance
- Dental Insurance
- Vision insurance
- Life insurance
Schedule:
- Full-time onsite (100% in-office)
- Hours of operations: 9am – 6pm
- Standard business hours Monday to Friday/weekends as needed
- Occasional travel may be required for meetings and training sessions.
Ability to commute/relocate:
- Reliably commute or planning to relocate before starting work (Required)
PHYSICAL DEMANDS Regularly sit/walk at a workstation in an office or cubicle setting. Must occasionally lift and/or move up to 25-50 pounds.
*Other duties may be assigned in support of departmental goals.
