Director, Risk Adjustment

What You’ll Do

The Director of Risk Adjustment is a strategic operational leader responsible for driving risk adjustment performance across Interwell Health’s payer and government programs. The Director will serve as a central leader in advancing Interwell’ s risk adjustment capabilities, with accountability for both execution and measurable results in a highly regulated environment. The Director will translate organizational strategy into scalable programs and support cross-functional teams across clinical, coding, analytics, and provider engagement. 

As the Director of Risk Adjustment, you will provide operational support, driving day-to-day operations, implementing new pilots, and running existing programs. In this role, you will play a critical part in assessing the opportunity for performance improvement, devising the approach for implementation of new strategies, and managing deployment of performance related initiatives for Nephrology providers. 

Essential Functions:

Enterprise Strategy & Organizational Leadership

• Lead the development and execution of enterprise-wide risk adjustment strategy aligned to clinical, operational, and financial priorities 
• Translate organizational goals (e.g., RAF improvement, recapture performance, coding accuracy) into actionable, scalable programs 
• Partner with executive leadership to align risk adjustment priorities across Medicare Advantage, CKCC, and commercial populations 
• Drive innovation and continuous improvement through advanced analytics, AI/NLP, and point-of-care enablement 

Three-Pronged Risk Adjustment Approach 

This role is accountable for designing and executing a comprehensive risk adjustment strategy anchored in three core pillars:

• Patient-Level Tracking: Build and operationalize longitudinal tracking of all suspected and recaptured conditions at the patient level—creating enterprise visibility comparable to medical cost tracking and enabling proactive management of coding gaps 
• Data Enrichment: Leverage analytics, predictive modeling, and external vendor partnerships to enhance suspecting logic, improve data completeness, and increase targeting precision 
• Execution Beyond Nephrology: Expand risk adjustment execution beyond nephrology by developing scalable processes to engage primary care providers (PCPs), health plans, and in-home programs to ensure comprehensive gap closure across the full continuum of care

Performance Ownership & Outcomes

• Establish KPIs, dashboards, and reporting cadences to ensure transparency and accountability 

• Translate performance into financial impact (e.g., PMPM, revenue lift) for executive and board-level communication 
• Identify risks to performance and implement mitigation strategies.
• Own and drive performance against key risk adjustment metrics, including: 
• RAF accuracy and trend performance 
• Recapture rates and gap closure 
• Coding accuracy and audit outcome

What You’ll Need:

Skills & Competencies:

Cross-Functional Leadership

• Serve as a central leader across clinical operations, analytics, product, compliance, and finance 
• Partner with analytics teams to refine suspecting models and performance measurement 
• Collaborate with clinical and provider-facing teams to embed risk adjustment into workflows at the point of care 
• Influence product and technology roadmaps (e.g., Epic integration, documentation tools) 

Team Leadership & Development

• Lead and develop a high-performing team responsible for risk adjustment operations and delivery 
• Establish clear goals, accountability, and performance expectations aligned with enterprise priorities 
• Foster a culture of ownership, continuous improvement, and compliance 

Compliance & Audit Readiness

• Ensure all risk adjustment activities meet CMS, payer, and regulatory requirements 
• Partner with compliance to mitigate risk and maintain coding integrity 
• Promote a culture of accurate, ethical, and defensible documentation

Education and Experience:

Required

• 8–12+ years of experience in risk adjustment, healthcare operations, or related field 
• Deep expertise in Medicare Advantage risk adjustment, HCC coding, and RAF methodology 
• Experience leading enterprise or multi-market risk adjustment programs (MA, CKCC, Commercial preferred) 
• Proven ability to translate strategy into execution and measurable outcomes 
• Strong financial acumen with ability to connect RAF performance to revenue impact 
• Demonstrated success leading cross-functional initiatives in complex healthcare environments 
• Experience building and leading high-performing teams

Preferred

• Bachelor’s degree in related field of study 

Travel Requirements:

• Up to 25% travel required.

Work Environment:

• 100% Remote