Director of Risk Adjustment Operations Position Available In Miami-Dade, Florida

Director of Risk Adjustment Operations Genuine Health Group Coral Gables, FL Job Details Full-time Estimated:

$103K – $127K a year 1 day ago Benefits Paid holidays Health insurance Dental insurance 401(k) Flexible spending account Paid time off Employee assistance program Vision insurance 401(k) matching Employee discount Flexible schedule Life insurance Qualifications Value-based care analysis Revenue growth Revenue cycle management Medicare Medical coding CMS Process improvement 3 years

ICD-10 EMR/EHR

Project management Presentation skills Bachelor’s degree Data analytics CPT coding Clinical documentation improvement Health information management Data visualization Senior level Leadership Communication skills

Full Job Description Summary:

The Director of Risk Adjustment Operations is responsible for leading and optimizing our risk adjustment operations within a value-based care environment. This position is responsible for developing and managing key performance indicators (KPIs), structuring processes for automation, and fostering a culture of accountability and efficiency. The ideal candidate will possess deep expertise in coding, risk adjustment, and compliance . Additionally, this role will integrate billing functions with value-based care metrics, HEDIS reporting, and risk adjustment strategies to optimize overall revenue performance and quality outcomes across MA, ACO and other payer models.

Essential Duties and Responsibilities:

Develop and execute strategic initiatives that strive to ensure proper alignment between revenue and true health status of the population we serve; improve efficiency and enhance financial performance. Implement structured workflows that support automation and drive seamless, scalable revenue cycle operations. Establish clear accountability frameworks, setting expectations for accuracy, turnaround times, and performance metrics across the revenue team. Define, track, report and continuously improve key performance indicators (KPIs) such as: Coding accuracy & compliance scores Risk adjustment factor (RAF) scores Use data-driven insights to identify bottlenecks, enhance workflow efficiency, and implement process improvements. Oversee and enhance coding processes to maximize reimbursement while ensuring compliance with federal, state, and payer guidelines. Establish a robust internal audit process for coding accuracy and proper documentation to minimize risk and prevent revenue leakage. Ensure processes align with risk adjustment strategies (HCC coding) and facilitate accurate HEDIS measure reporting to support value-based contracts. Monitor regulatory changes and payer policies, ensuring billing practices remain compliant and optimized for reimbursement. Proactively update workflows and team education in response to policy changes affecting reimbursement and coding. Collaborate cross-functionally with clinical, compliance, finance, analytics, and operations teams to drive VBC-aligned revenue performance. Manage projects with external vendors to achieve scale and maximum efficiency. Gather and review evidence development builds (retrospective claims analysis, etc.) Synthesize large data sets into succinct, actionable presentations. Interpret information clearly and accurately to concisely communicate outcomes and recommendations to stakeholders, executive management, etc. Report outcomes and progress against budget to key leadership and other external stakeholders. Create stakeholder-facing reporting packages to communicate financial trends, coding performance, quality outcomes, and value-based revenue impact Design and build internal tools, dashboards, and trackers to monitor performance, identify gaps, and guide interventions across the revenue cycle. Performs other duties as required Knowledge, Skills and Abilities Excellent written and verbal communication skills of complex healthcare data Excellent leadership, management, and project management and presentation skills Ability to work independently and demonstrate initiative in identifying problems, creating solutions, and developing systems to maximize effectiveness. Promote cross-departmental collaboration to ensure alignment between operations, finance, and clinical teams. Effective problem solving and ability to analyze and use data for decision making. Strong interpersonal skills with the ability to effectively collaborate across teams. Strong work ethic and ability to work independently or with others in a high production environment. Strong project management experience with ability to prioritize, focus, and maintain flexibility in a fast-paced environment. Minimum Education and Experience 5+ years of progressive experience in revenue cycle management, preferably within managed care, risk-bearing entities, or value-based care models. Deep understanding of medical coding (CPT, ICD-10, HCC risk adjustment), billing, compliance, and reimbursement. Experience managing value-based care revenue strategies, including HEDIS measures and risk adjustment capture. Proven ability to develop, track, and drive improvement in KPIs that impact financial performance. Experience leading high-performance risk adjustment/revenue teams and fostering a culture of accountability. Expertise in billing system optimization and integration with electronic health records (EHRs). Occasional local road travel of up to 20% or once per week Genuine Health Group offers a competitive compensation and benefits package that includes a 401k matching program, fully subsidized medical plans, paid holidays and much more. Base salary will be commensurate to professional experience. Genuine Health Group is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Job Type:

Full-time Benefits:

401(k) 401(k) matching Dental insurance Employee assistance program Employee discount Flexible schedule Flexible spending account Health insurance Life insurance Paid time off Vision insurance

Schedule:

8 hour shift Monday to Friday Application Question(s): Will you now or in the future require sponsorship (e.g., H-1B, O-1, TN, etc.) for employment in the United States? What is your salary expectation for this position? Please describe your experience and accountability level for KPI’s, performance metrics, and stakeholder reporting and/or presentations.

Education:

Bachelor’s (Required)

Experience:

stakeholder presentation and reporting: 3 years (Required) risk adjustment audit and regulatory compliance: 3 years (Required) healthcare risk adjustment and reimbursement: 5 years (Required) Willingness to travel: 25% (Required)

Work Location:

Hybrid remote in Coral Gables, FL 33134