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Senior Director Performance Risk Adjustment Jobs

CareFirst

Senior Risk Adjustment Analyst

Baltimore, MD · Hybrid

Support management in ensuring that key risk adjustment performance metrics and business objectives ... Position does not have direct reports but is expected to assist in guiding and mentoring less ...

HealthEdge

Director, Risk Adjustment Products

The Director, Risk Adjustment Products will lead the strategy, roadmap, and execution for the ... Establish and track KPIs that measure both risk adjustment performance and interoperability success ...

HealthEdge

The Director, Risk Adjustment Products will lead the strategy, roadmap, and execution for the ... Establish and track KPIs that measure both risk adjustment performance and interoperability success ...

Mass Advantage

Manager, Risk Adjustment

Worcester, MA · On-site

This position is responsible for the strategy, execution and performance of Medicare risk ... senior products; leading and coordinating enterprise risk adjustment initiatives, working with the ...

JLL

Senior Director, Performance Management

Raleigh, NC · On-site

Senior Director, Performance Management - JLL What this job involves: We are seeking a leader to join our team as Senior Director, Performance Management. This leader will lead performance delivery ...

JLL

Senior Director, Performance Management

Boston, MA · On-site

Senior Director, Performance Management - JLL What this job involves: We are seeking a leader to join our team as Senior Director, Performance Management. This leader will lead performance delivery ...

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Senior Director Performance Risk Adjustment information

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$39.5K

$142.9K

$279.5K

How much do senior director performance risk adjustment jobs pay per year?

As of Jun 8, 2026, the average yearly pay for senior director performance risk adjustment in the United States is $142,920.00, according to ZipRecruiter salary data. Most workers in this role earn between $101,500.00 and $161,000.00 per year, depending on experience, location, and employer.

How does a Senior Director of Performance Risk Adjustment typically collaborate with cross-functional teams to improve organizational outcomes?

As a Senior Director of Performance Risk Adjustment, you will frequently work with teams across clinical operations, data analytics, compliance, and finance to drive risk adjustment initiatives. This involves coordinating with clinicians to ensure accurate documentation, partnering with analysts to interpret performance data, and collaborating with compliance teams to maintain regulatory standards. Effective communication and leadership skills are essential, as you'll lead strategy sessions, oversee project implementation, and align stakeholders toward shared goals. This collaborative environment not only drives organizational success but also provides opportunities for professional growth and exposure to different facets of the healthcare industry.

What are the key skills and qualifications needed to thrive as a Senior Director of Performance Risk Adjustment, and why are they important?

To thrive as a Senior Director of Performance Risk Adjustment, you need deep expertise in risk adjustment methodologies, data analysis, healthcare regulations, and typically a degree in healthcare, finance, or a related field. Familiarity with platforms like SAS, SQL, and risk adjustment software, as well as certifications such as Certified Risk Adjustment Coder (CRC), are highly valuable. Strategic leadership, strong communication, and the ability to collaborate across clinical, technical, and executive teams are essential soft skills. These competencies ensure accurate risk scoring, regulatory compliance, and the financial health of healthcare organizations in value-based care environments.

What is the difference between Senior Director Performance Risk Adjustment vs Senior Director Healthcare Analytics?

AspectSenior Director Performance Risk AdjustmentSenior Director Healthcare Analytics
Primary FocusManaging risk adjustment processes, optimizing coding accuracy, and ensuring compliance for reimbursementAnalyzing healthcare data to improve clinical outcomes and operational efficiency
Required CredentialsHealthcare administration, coding certifications, or related experienceData analysis, statistics, or healthcare informatics background
Work EnvironmentHealthcare organizations, insurance companies, or risk adjustment vendorsHospitals, healthcare systems, or analytics firms
Industry UsageCommonly used in payer and provider settings focusing on risk managementUsed across healthcare organizations emphasizing data-driven decision making

While both roles operate within the healthcare industry, the Senior Director Performance Risk Adjustment primarily focuses on managing risk adjustment processes to ensure accurate reimbursement, whereas the Senior Director Healthcare Analytics concentrates on analyzing healthcare data to improve outcomes and efficiency. Understanding these distinctions helps organizations align leadership roles with strategic goals.

What does a Senior Director of Performance Risk Adjustment do?

A Senior Director of Performance Risk Adjustment leads and oversees strategies to ensure accurate risk adjustment data collection and reporting for healthcare organizations. This role involves managing teams, ensuring compliance with regulations, analyzing data to optimize reimbursement, and collaborating with other departments to improve coding accuracy and performance. They play a critical part in ensuring the organization receives appropriate funding based on the health status of its insured population. Senior Directors also stay updated on policy changes and guide the organization in adapting to evolving industry standards.
Infographic showing various Senior Director Performance Risk Adjustment job openings in the United States as of May 2026, with employment types broken down into 94% Full Time, and 6% Contract. Highlights an 83% In-person, and 17% Remote job distribution, with an average salary of $142,920 per year, or $68.7 per hour.
Director, Risk Adjustment - Hybrid

Director, Risk Adjustment - Hybrid

EmblemHealth

New York, NY • Hybrid

Other

Posted 20 days ago

Job description

Summary of Job

Develop and execute a comprehensive annual Risk Adjustment strategy that supports the Company strategies and improves the quality of care delivered to Emblem members, and to ensure the plan reimbursement accurately reflects the clinical diagnosis of our Medicare, Medicaid, and Affordable Care Act (ACA) members.  Develop and execute an annual Provider Risk Adjustment strategy to improve the accuracy of their diagnosis coding through education and engagement of our risk adjustment programs, reimbursement models and the ongoing development/ enhancement of support capabilities that complement their clinical practice model.  Prepare and present provider risk adjustment results at all Emblem joint operating committee meetings and monthly risk adjustment operational meetings.  Select and manage best-in-class risk adjustment vendors to drive continual improvement in the accuracy of diagnosis coding for Medicare, Medicaid, and ACA members.  Manage the ongoing performance, compliance and return on investment for each risk adjustment vendor.  Create and maintain a capabilities framework that is member and provider centric and is appropriate given for the clinical and demographic dynamics of members in risk adjusted products.  Manage the creation and timely production of risk adjustment operation and financial performance reports for all risk adjustment programs, and lead monthly risk adjustment operation meetings with Emblem leaders for VP, Risk Adjustment.  Be a strategic partner with the Actuarial, Quality and Product teams to enhance risk adjustment interventions and results.  Establish enterprise-wide monitoring and reconciliation reports to ensure that risk adjustment vendor results are accurately, timely and completely submitted to government entities.

Responsibilities

  • Develop, manage, and improve all retrospective risk adjustment programs to retrospectively identify, retrieve, code and submit diagnostic information from providers on EmblemHealth members enrolled in Medicare, Medicaid, and ACA products; manage all vendor relationships that support these retrospective activities.
     
  • Develop, manage, and improve prospective and concurrent risk adjustment programs to ensure accurate capture and reporting of diagnostic information for EmblemHealth members enrolled in Medicare, Medicaid and ACA products. 
     
  • Work with risk adjustment vendors and providers to execute in office assessment programs through which they 1) identify members based on clinical needs and quality gaps, 2) outreach to patients to encourage them to make office visits to receive services and 3) completely and accurately document all diagnostic conditions. 
     
  • Manage the In-Home Assessment risk adjustment vendor program.
     
  • Manage team completing revenue management opportunities for Medicaid, Medicare and Health Exchange products which includes identification of risk score opportunities, suspects, analysis and tracking of performance and attribution of interventions.
     
  • Direct EmblemHealth provider relationship and engagement risk adjustment activities.
     
  • Direct interaction with the CFO, CEO and other physician leaders of ACPNY groups and other large, sophisticated medical groups to integrate our programs into the provider's operations.
     
  • Analyze data to identify submission trends against historic data and membership changes and recommend opportunities to improve accuracy and completeness of all government submissions.
     
  • Collaborate with EmblemHealth medical management, quality, marketing & sales and network departments to identify opportunities to achieve efficiencies and improve effectiveness of risk adjustment activities by integrating both prospective and retrospective programs with care management, CMS Stars, Medicaid and Health Exchange quality programs, sales outreach and provider contracting. 

Qualifications

  • Bachelor's Degree in Healthcare, Finance, Business, or related field  (Required); Master's degree  (Preferred)
     
  • 10 - 12+ years of relevant, professional work experience  (Required)
     
  • Experience in healthcare, plan or provider operations and relations or related experience  (Required)
     
  • Leadership experience - including staff and process management experience  (Required)
     
  • Risk adjustment knowledge and expertise across Medicare, Medicaid, and Commercial exchange  (Required)
     
  • Capacity to multi-task at high detail-oriented level  (Required)
     
  • Strong communication skills (verbal, written, presentation, interpersonal) including executive leaders meeting experience  (Required)
     
  • Strong working knowledge of MS Office - Word, Excel, PowerPoint, Access, Outlook  (Required)
     
  • Strong analytical and logical skills paired with strong attention to detail  (Required)
Additional Information
  • Requisition ID: 1000003033
  • Hiring Range: $135,000-$253,800

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