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Director Medicare Risk Adjustment Jobs in Park Ridge, IL

Bcbsa

Head of Medicare Performance Hub

Chicago, IL · On-site

The Senior Director, Medicare Performance Hub (MPH) is a leadership role within the Blue Cross Blue ... Proactively identify benchmarks and performance targets across Stars, Risk Adjustment, and Medical ...

Bcbsa

Medicare Plan Management Principal

Chicago, IL · Hybrid

... Risk Adjustment, and Medical Cost Management - into clear, compelling guidance that Plans can act on. * Serve as the primary relationship owner between BCBSA and the Plans for the national Medicare ...

Deloitte

Medicaid Actuarial Senior Manager

Chicago, IL · On-site

Experience with risk adjustment mechanisms * Experience with Provider reimbursement streams (i.e ... Experience with Medicare products, including Medicare Advantage or Medicare Supplement products for ...

Deloitte

Medicaid Actuarial Senior Manager

Chicago, IL · On-site

Experience with risk adjustment mechanisms * Experience with Provider reimbursement streams (i.e ... Experience with Medicare products, including Medicare Advantage or Medicare Supplement products for ...

Deloitte

Medicaid Actuarial Manager

Chicago, IL · On-site

Experience with risk adjustment mechanisms * Experience with Provider reimbursement streams (i.e ... Experience with Medicare products, including Medicare Advantage or Medicare Supplement products for ...

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All JobsMedicare Risk Adjustment JobsDirector Medicare Risk Adjustment JobsDirector Medicare Risk Adjustment Jobs in Park Ridge, IL

Director Medicare Risk Adjustment information

See Park Ridge, IL salary details

$100.4K

$133.7K

$141.2K

How much do director medicare risk adjustment jobs pay per year?

As of Aug 23, 2026, the average yearly pay for director medicare risk adjustment in Park Ridge, IL is $133,690.00, according to ZipRecruiter salary data. Most workers in this role earn between $135,300.00 and $138,700.00 per year, depending on experience, location, and employer.

What does a director Medicare Risk Adjustment do?

A Director of Medicare Risk Adjustment oversees the strategy, operations, and compliance of risk adjustment programs for Medicare Advantage plans. They ensure accurate data collection, coding, and submissions to optimize reimbursement while maintaining regulatory compliance. This role involves collaborating with cross-functional teams, managing analytics, and implementing initiatives to improve documentation and risk score accuracy. Additionally, they monitor policy changes and adjust processes to align with evolving CMS regulations.

What are the key skills and qualifications needed to thrive as a director Medicare Risk Adjustment?

To thrive as a Director Medicare Risk Adjustment, you need a strong background in healthcare administration, Medicare regulations, data analytics, and risk adjustment methodologies, often supported by a bachelor's or master's degree in a related field. Familiarity with risk adjustment software, claims processing systems, and proficiency in data analysis tools like SQL or SAS is essential, and certifications such as CRC (Certified Risk Adjustment Coder) can be advantageous. Outstanding leadership, cross-functional collaboration, and strong communication skills help drive teams toward accurate documentation and coding compliance. These competencies are crucial for optimizing revenue, ensuring regulatory adherence, and guiding strategic organizational initiatives in a complex healthcare environment.

What are some common challenges faced by a director Medicare Risk Adjustment, and how do they impact daily work?

Directors of Medicare Risk Adjustment frequently tackle challenges such as interpreting evolving CMS guidelines, ensuring complete and accurate documentation, and aligning interdepartmental teams around risk adjustment best practices. Keeping up with regulatory changes, managing large data sets, and training staff on coding compliance are all critical aspects of the job. These challenges require strong analytical skills, attention to detail, and the ability to communicate complex information to various stakeholders. Addressing these issues effectively is key to maintaining compliance, optimizing revenue accuracy, and helping your organization deliver quality care to Medicare populations.

What are popular job titles related to Director Medicare Risk Adjustment jobs in Park Ridge, IL?

For Director Medicare Risk Adjustment jobs in Park Ridge, IL, the most frequently searched job titles are:

What job categories do people searching Director Medicare Risk Adjustment jobs in Park Ridge, IL look for?

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Cities near Park Ridge, IL with the most Director Medicare Risk Adjustment job openings:

Director Medicare Risk Adjustment jobs near you

Senior Manager, Corporate Compliance - Risk Adjustment

CVS Health

Northbrook, IL • On-site

$75K - $165K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted yesterday

CVS Health rating

5.8

Company rating: 5.8 out of 10

Based on 4,341 frontline employees who took The Breakroom Quiz

91st of 113 rated pharmacies

Job description

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselvesaccountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Position Summary

As a Senior Manager, Medicare Compliance - Risk Adjustment, you are responsible for overseeing and maintaining compliance with CMS regulations related to Medicare Advantage Risk Adjustment, Hierarchical Condition Categories (HCCs), encounter data submission, documentation and coding compliance, and related regulatory requirements. This position serves as a key compliance leader and subject matter expert, partnering with Risk Adjustment Operations, Coding, Provider Education, Clinical Documentation Improvement (CDI), Internal Audit, Legal, and Government Affairs teams to ensure organizational adherence to CMS requirements.

The ideal candidate possesses extensive experience in Medicare Advantage compliance and a deep understanding of CMS Risk Adjustment methodologies, diagnosis coding requirements, medical record documentation standards, RADV audits, and evolving regulatory guidance.

Key Responsibilities

  • Lead the Medicare Advantage Risk Adjustment compliance program.

  • Monitor and interpret CMS regulations, HPMS memoranda, Final Rules, Medicare Managed Care Manual guidance, RADV requirements, and OIG enforcement activities.

  • Assess operational processes for compliance risks related to risk adjustment activities.

  • Develop and implement corrective action plans for identified compliance issues.

  • Conduct compliance risk assessments related to coding, documentation, and encounter data submissions.


Required Qualifications

  • Minimum 7 years of experience in Medicare Advantage, Risk Adjustment, Coding Compliance, Audit, or Regulatory Compliance

  • Minimum 5 years in a leadership role

  • One or more of the following certifications: CPMA (Certified Professional Medical Auditor), CRC (Certified Risk Adjustment Coder), CPC (Certified Professional Coder), CCS (Certified Coding Specialist)

  • Willingness to travel up to 10% (including by plane)


Preferred Qualifications

  • Health Information Management (RHIA/RHIT)

  • Nursing - Strong understanding of clinical documentation and medical record review

  • Certified Risk Adjustment Coder (CRC) with compliance experience

  • Provider coding audit/compliance leadership experience

  • Medicare Advantage compliance leadership experience supporting RADV, HCC validation, and CMS audits


Education

Bachelor's degree in Health Information Management, Healthcare Administration, Nursing, Public Health, Business Administration, Healthcare Compliance, or a related healthcare field required; equivalent years of work experience may substitue.

Pay Range

The typical pay range for this role is:

$75,400.00 - $165,954.00


This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This fulltime position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial wellbeing of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.


Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 08/12/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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