Director of HCC Risk Adjustment

1 day ago Be among the first 25 applicants

Get AI-powered advice on this job and more exclusive features.

Imperial Health Plan of California, Inc. provided pay range

This range is provided by Imperial Health Plan of California, Inc.. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$130,000.00 / yr - $155,000.00 / yr

ON SITE IN PASADENA, CA

About the Role

Risk Adjustment Manager is responsible for leading and optimizing risk adjustment operations across all lines of business and entities, including Medicare Advantage, Marketplace, and other affiliated health plans, medical groups, and MSO functions. This role serves as a subject matter expert on federal risk adjustment regulations, policies, and methodologies. The position involves close collaboration with internal teams, providers, and external partners to improve risk score accuracy, provider engagement, and regulatory compliance. The Sr. Manager will also lead the development and operationalization of reporting tools, analytics, and workflows to support risk adjustment performance and data integrity across programs. This role plays a key part in aligning cross‑functional teams, driving RADV audit readiness, and informing enterprise‑level decisions related to financial forecasting, coding accuracy, and population health.

Responsibilities

• Lead Risk Adjustment Strategy & Operations : Oversee the development, implementation, and continuous improvement of risk adjustment programs across all lines of business, including Medicare Advantage (CMS‑HCC), Marketplace (HHS‑HCC), and RxHCC models, ensuring regulatory compliance, coding accuracy, and risk score optimization.
• Stay Current on Model Versions & Methodologies : Maintain deep expertise in CMS‑HCC model updates (e.g., V24 vs. V28), RxHCC methodology for Medicare Part D, and HHS‑HCC annual model recalibrations, including normalization factors, coding intensity adjustments, and future model transitions as released in CMS Advance Notices and Final Rate Announcements.
• Manage Department Staff & Cross‑Functional Teams : Provide strategic direction and oversight for Risk Adjustment and coding department staff. Assemble and lead cross‑functional and ad hoc teams for specific initiatives such as RADV audit readiness, encounter accuracy improvement, and provider education.
• Build and Manage Risk Adjustment Reporting & BI Tools : Design, implement, and maintain dashboards and reporting tools to monitor performance metrics such as risk score trends, gap closure rates, encounter completeness, RxHCC attribution, and audit readiness benchmarks.
• Conduct Data Gap Analysis & Targeted Program Design : Perform thorough analyses to identify documentation, coding, and encounter data gaps. Use findings to develop targeted retrospective and prospective strategies to improve risk capture and data completeness, especially in hard‑to‑reach or low‑utilization populations.

Education & Experience

Seniority level

Director

Employment type

Full‑time

Job function

Public Relations, Analyst, and Health Care Provider

Industries

Insurance

Referrals increase your chances of interviewing at Imperial Health Plan of California, Inc. by 2x

Los Angeles Metropolitan Area $120,000.00-$150,000.00 2 weeks ago

Los Angeles, CA $110,000.00-$120,000.00 3 weeks ago

#J-18808-Ljbffr