Freelance Remote Risk Adjustment Coder Jobs in Albuquerque, NM

Location Address:
9521 San Mateo NEAlbuquerque, NM 87113-2237
Summary:
The Director, Stars & Member Experience provides strategic leadership for Presbyterian Health Plan's Medicare Star Ratings, CAHPS, Health Outcomes Survey (HOS), and Member Experience programs. This position is responsible for leading the Star program and developing and executing enterprise strategies that improve member experience, quality outcomes, and financial performance while supporting the organization's strategic and regulatory objectives.
The Director leads the Member Experience Program and serves as the organization's primary expert in member experience strategy and customer insights across all LOBs as well as the Medicare Stars program. Through influence and collaboration, this leader promotes a member-centered culture and ensures that the voice of the member is incorporated into organizational decision-making, program design, quality initiatives, and operational strategies.
This role is accountable for Medicare Star Ratings performance, CAHPS and HOS outcomes, member experience measurement, survey administration, vendor oversight, and enterprise-wide improvement efforts designed to achieve exceptional member experiences and quality results.
Work Arrangement:
• Remote: Open to applicants in the United States, excluding CA, IL, ND, NY, OH, WA, and WY.
• Hybrid (Strongly Preferred): For individuals within 60 miles of Albuquerque, in-office presence is required Tuesday through Thursday.
Job Description:
Responsibilities
• Develop and execute the organization's Medicare Stars strategy to achieve annual quality and financial performance goals.
• Lead enterprise efforts to improve Star Ratings, CAHPS results, HOS outcomes, and member satisfaction.
• Establish governance structures, performance goals, and accountability frameworks for Stars-related initiatives.
• Monitor performance trends and identify opportunities to improve clinical quality, member experience, and operational effectiveness in collaboration with Quality Performance Improvement team and the HEDIS operations team,
• Partner with Population Health, Behavioral Health, Risk Adjustment, Provider Relations, Customer Service, Network Management, and Care Management teams to improve performance outcomes.
• Lead the design and implementation of member-centric experiences across the organization.
o Identify strategic opportunities to improve the member journey and collaborate with stakeholders to redesign processes and services.
o Promote a culture where member impact is a key consideration in organizational decision-making.
o Stay current on emerging customer experience methodologies, best practices, and industry trends.
o Translate member insights into actionable recommendations for business leaders.
o Analyze member feedback, survey results, complaints, grievances, and operational data to identify trends and improvement opportunities.
o Develop a deep understanding of member needs, expectations, motivations, and barriers through research and data analysis.
• Oversee administration of member experience measurement programs, including CAHPS, HOS, satisfaction surveys, and other voice-of-customer tools.
• Recommend strategic priorities and improvement initiatives designed to strengthen member satisfaction and quality outcomes.
• Anticipate risks that may impact organizational performance and proactively escalate concerns and recommended actions.
• Present performance reports and strategic recommendations to executive leadership, quality committees, and governing bodies.
• Lead enterprise-wide improvement initiatives focused on member experience and quality performance.
• Ensure improvement efforts are supported by appropriate methodologies, documentation, tracking, and alignment with organizational strategic goals.
• Partner with operational leaders to implement targeted interventions that improve survey performance and member outcomes.
• Evaluate effectiveness of initiatives and communicate progress, outcomes, and lessons learned.
• Define key performance indicators that measure what matters most to members.
• Develop executive dashboards and board-level metrics related to Stars, CAHPS, HOS, and member experience.
• Establish performance monitoring and reporting processes that drive accountability and transparency.
• Communicate insights, trends, opportunities, and performance results across the organization.
• Recommend innovative approaches that improve engagement, satisfaction, access, outcomes, and retention.
• Evaluate program effectiveness and support the development of future strategies and investments.
• Oversee vendors supporting member experience, CAHPS, HOS, outreach, and engagement activities.
• Monitor vendor performance and ensure contractual expectations and quality outcomes are achieved.
• Ensure effective administration of survey activities and member engagement efforts.
Additional Job Description:
Qualifications
• Bachelor's degree in Healthcare Administration, Public Health, Business Administration, Nursing, Marketing, Customer Experience, or related field required, Master's degree preferred.
• Customer Experience certification, CPHQ, or related certification preferred.
• Demonstrated success improving Medicare Stars, CAHPS, HOS, and consumer experience measures.
• 7+ years of progressive leadership experience in healthcare quality, member experience, Medicare Advantage, population health, or managed care.
• Minimum 3 years leading teams and cross-functional initiatives.
• Experience developing strategic improvement programs and influencing executive stakeholders.
• Healthcare, health plan, or managed care experience strongly preferred.
• Experience in project management, process improvement, and organizational change leadership preferred.
Core Competencies
• Medicare Stars expertise
• Member experience and customer journey design
• CAHPS and HOS strategy
• Quality improvement methodology
• Healthcare analytics and performance management
• Executive communication and influence
• Strategic planning
• Cross-functional leadership
• Change management
Benefits
Benefits are effective day-one (for .45 FTE and above) and include:

• Competitive salaries
• Full medical, dental and vision insurance
• Flexible spending accounts (FSAs)
• Free wellness programs
• Paid time off (PTO)
• Retirement plans, including matching employer contributions
• Continuing education and career development opportunities
• Life insurance and short/long term disability programs

About Us
Presbyterian Healthcare Services is a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, it is the state's largest private employer with approximately 11,000 employees.
Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, employees, board members, and other volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than 700,000 New Mexicans.
We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.
About New Mexico
New Mexico's unique blend of Spanish, Mexican and Native American influences contribute to a culturally rich lifestyle. Add in Albuquerque's International Balloon Fiesta, Los Alamos' nuclear scientists, Roswell's visitors from outer space, and Santa Fe's artists, and you get an eclectic mix of people, places and experiences that make this state great.
Cities in New Mexico are continually ranked among the nation's best places to work and live by Forbes magazine, Kiplinger's Personal Finance, and other corporate and government relocation managers like Worldwide ERC.
New Mexico offers endless recreational opportunities to explore, and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.