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Senior Director Performance Risk Adjustment Jobs

Point32health

Risk Adjustment Consultant

Canton, MA · On-site

Support the evaluation of medical group opportunities and challenges specific to risk adjustment performance, identify and/or modify training needs and/or programmatic interventions to improve ...

Privia Health

National Director, Risk Adjustment

$130K - $160K/yr

The National Director, Risk Adjustment identifies and implements initiatives to achieve complete ... This leader monitors corporate and market performance and also partners with analytics, data, and ...

Privia Health

National Director, Risk Adjustment

$130K - $160K/yr

The National Director, Risk Adjustment identifies and implements initiatives to achieve complete ... This leader monitors corporate and market performance and also partners with analytics, data, and ...

Oscar Health

Auditor, Risk Adjustment

Tempe, AZ · Remote

$82K - $108K/yr

Review the performance of the Risk Adjustment Coding team and report audit trends to Leadership in a timely, consistent and effective manner to ensure the appropriate changes and education are ...

Oscar Health

Auditor, Risk Adjustment

Miami, FL · Remote

$82K - $108K/yr

Review the performance of the Risk Adjustment Coding team and report audit trends to Leadership in a timely, consistent and effective manner to ensure the appropriate changes and education are ...

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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.

Sr. Manager, Risk Adjustment & Quality

Centrum Health

Doral, FL

Other

Posted 25 days ago

Job description

Centrum Health's Sr. Manager of Risk Adjustment and Quality will be responsible for managing a team of Risk Adjustment Coders, HEDIS specialists, Billers, and Auditors to maintain daily billing and coding operations for our wholly owned clinics and affiliated practices. In this role, the candidate must excel at cross-departmental collaboration with Physicians, Clinical Operations, Data/Technology, and Finance teams.

The individual must be a subject matter expert in ACA, Medicare Advantage, Medicaid risk adjustment, billing, and quality operations. The position delivers best-in-class results while operating under strict regulatory adherence and a strong compliance mindset.

This is an onsite position in Doral, FL.

ROLE RESPONSIBILITIES

The core function of this role includes management of risk adjustment, medical records, coding, and billing operations.
Lead a team to drive risk adjustment performance across Medicare Advantage, ACO, Medicaid, and ACA lines of business.
Provide thought leadership in the continued development of the Risk Adjustment and Quality function, including collaboration with analytics and internal technology teams to develop a Risk Adjustment and Quality Suspecting Engine.

Work closely with internal technical teams to develop in house tools to support Risk Adjustment operations.
Provide leadership and overall program management for retrospective and prospective encounter facilitation, supplemental data submission, virtual visits, and in-office assessments.
Collaborate with Actuarial and Analytics teams to design and implement suspecting and segmentation strategies for prospective and retrospective programs.
Develop short-term, quick-win initiatives as well as long-term, analytics-driven gap-closure programs and tools.
Communicate complex concepts to non-technical business stakeholders across the full business cycle-from question identification through results interpretation-including data integrity considerations.
Ensure Centrum Health's ability to meet federal and state regulatory compliance and reporting requirements, including RADV audits, on an annual basis.
Perform other duties and responsibilities as assigned.
This position will have direct and indirect supervisory responsibility for risk adjustment program execution and analytics functions.
Occasional travel may be required.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

  • Bachelor's degree in a healthcare-related field or equivalent experience, required.
  • Six (6) or more years of experience in healthcare Risk Adjustment required.
  • Experience working with primary care providers and practices in value-based care.
  • Three (3) or more years of leadership experience managing and mentoring teams.
  • CPC, CRC, and CPMA certifications are highly preferred.
  • Experience working with Medicare Advantage, ACA, and Medicaid health plans is preferred.
  • Working knowledge of business intelligence tools and their application in driving business decisions.
  • Experience with in-home and virtual engagement capabilities, preferred.
  • Bilingual in Spanish and English required.

PROFESSIONAL COMPETENCIES

Ability to lead and mentor a highly skilled team.
Ability to frame and execute end-to-end analyses in collaboration with business and technical stakeholders.
Expertise in advanced data analysis to identify opportunities and design programs to capture value.
Experience managing third-party service providers, including TPAs and medical record/chart retrieval functions.
Eager learner; collaborative partner; clear communicator; and detail-oriented analyst.
Strong passion for empirical research and data-driven decision-making.
Experience maintaining payer file integrations and developing performance dashboards using data from multiple reporting sources.

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