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Vice President Hcc Risk Adjustment Coder Jobs (NOW HIRING)

Molina Healthcare

VP, Risk Adjustment

Long Beach, CA · On-site +1

$137K - $184K/yr

Drives organizational risk adjustment policy, program standards, and performance, and maintains ... coding results, encounter submission rates, HCC documentation outcomes, and performance against ...

Pedim

HCC Coder

Lecanto, FL · On-site

$13.75 - $18.50/hr

The Role We are seeking a proactive and compassionate HCC Coder to join our Primary Care team ... This role is critical to ensuring accurate risk adjustment, complete documentation, and compliance ...

PedIM Healthcare

HCC Coder

Lecanto, FL

$13.75 - $18.50/hr

The Role We are seeking a proactive and compassionate HCC Coder to join our Primary Care team ... This role is critical to ensuring accurate risk adjustment, complete documentation, and compliance ...

Harris Health System

Risk Adjustment Coder II

Houston, TX · On-site

$27.69 - $34.61/hr

Job Profile JOB SUMMARY The Risk Adjustment Coder II provides advanced support for complex medical record reviews to ensure the correct capture of chronic conditions and complexities to calculate a ...

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All JobsVice President Hcc Risk Adjustment Coder Jobs

Vice President Hcc Risk Adjustment Coder information

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$85.5K

$176.7K

$264K

How much do vice president hcc risk adjustment coder jobs pay per year?

As of Jun 27, 2026, the average yearly pay for vice president hcc risk adjustment coder in the United States is $176,675.00, according to ZipRecruiter salary data. Most workers in this role earn between $137,000.00 and $205,000.00 per year, depending on experience, location, and employer.

What is the difference between Vice President Hcc Risk Adjustment Coder vs Hcc Risk Adjustment Coder?

AspectVice President Hcc Risk Adjustment CoderHcc Risk Adjustment Coder
CredentialsAdvanced certifications, leadership experienceCertifications like CPC, CCS, or RHIT
Work EnvironmentExecutive-level, strategic planningOperational, coding departments
Industry UsageUsed in large healthcare organizations, insurersCommon in hospitals, clinics, coding firms

The Vice President Hcc Risk Adjustment Coder focuses on strategic leadership and oversight of risk adjustment coding programs, often requiring advanced certifications and leadership skills. In contrast, the Hcc Risk Adjustment Coder handles day-to-day coding tasks, ensuring accurate HCC coding based on medical records. Both roles are vital in healthcare risk management but differ mainly in scope, responsibilities, and experience level.

What are some common challenges faced by a Vice President HCC Risk Adjustment Coder, and how can they be managed?

A Vice President HCC Risk Adjustment Coder often faces the challenge of ensuring coding accuracy and compliance across large teams while keeping up with evolving CMS guidelines. Managing remote or distributed coding staff, integrating new technology solutions, and balancing productivity with quality assurance are also common hurdles. Success in this role requires strong communication skills, ongoing coder education, and the implementation of robust audit processes to maintain data integrity and regulatory compliance.

What are Vice President HCC Risk Adjustment Coders?

A Vice President HCC (Hierarchical Condition Category) Risk Adjustment Coder is a senior executive responsible for overseeing the medical coding operations related to risk adjustment in healthcare organizations. They lead teams that ensure accurate coding of patient diagnoses and health information, which impacts how healthcare providers are reimbursed by insurance payers, especially Medicare Advantage plans. Their role typically involves compliance oversight, quality assurance, training coders, and strategic planning to optimize risk scores. These professionals require extensive experience in medical coding, deep knowledge of HCC models, and strong leadership skills. They play a critical part in helping organizations maximize compliant reimbursement and improve patient outcomes.

What are the key skills and qualifications needed to thrive as a Vice President HCC Risk Adjustment Coder, and why are they important?

To thrive as a Vice President HCC Risk Adjustment Coder, you need deep expertise in HCC coding, risk adjustment methodologies, healthcare regulations, and a relevant certification such as CPC, CRC, or CCS. Mastery of coding software, EHR systems, and data analytics platforms is typically required. Leadership, strategic thinking, attention to detail, and strong communication skills distinguish top performers in this role. These skills are crucial for ensuring coding accuracy, regulatory compliance, and driving organizational success in value-based care environments.
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Vice President Hcc Risk Adjustment Coder jobs near you
Infographic showing various Vice President Hcc Risk Adjustment Coder job openings in the United States as of June 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $176,675 per year, or $84.9 per hour.
VP, Risk Adjustment

VP, Risk Adjustment

Molina Healthcare

Long Beach, CA • On-site, Remote

$137K - $184K/yr

Full-time

Posted 12 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 192 frontline employees who took The Breakroom Quiz

144th of 263 rated insurance

Job description


JOB DESCRIPTION Job Summary
Provides executive level strategy and leadership for the operational integrity and regulatory compliance of the organization's risk adjustment operations across all lines of business, including Medicare Advantage, Medicaid, and Affordable Care Act (ACA) Marketplace. Drives organizational risk adjustment policy, program standards, and performance, and maintains close partnerships with senior leaders across Clinical Operations, Analytics, Strategy, Technology, Encounters, Legal, and Compliance.
Essential Job Duties
  • Provides executive oversight of all risk adjustment programs across Medicare Advantage, Medicaid, and ACA Marketplace lines of business, ensuring alignment of operational activities with organizational objectives and regulatory requirements. Supporting programs across the enterprise including interaction at the state plan level.
  • Leads end-to-end program management for chart review initiatives, in-home assessments (IHA), provider clinical programs, and supplemental data efforts across all applicable lines of business.
  • Serves as the primary internal interface for the organization's IHA capability, coordinating between internal teams and external IHA vendors engaged for supplemental capacity.
  • Manages provider-facing clinical programs, including in-office assessments, ensuring program design and execution are consistent with documentation and coding standards.
  • Establishes, maintains, and enforces enterprise-wide coding standards and Clinical Documentation Improvement (CDI) protocols applicable across all lines of business.
  • Oversees coding quality evaluation processes, ensuring accuracy, consistency, and compliance with Centers for Medicare and Medicaid Services (CMS) Hierarchical Condition Category (HCC) methodology, Medicaid risk adjustment guidelines, and ACA Marketplace risk adjustment requirements as applicable.
  • Owns and governs the end-to-end data flow from coding vendor output through internal quality assurance review to encounter staging, maintaining clear accountability at each stage of the process.
  • Partners with the Encounters team to ensure the timely, accurate, and compliant submission of encounter records, including both additions and deletions, across all applicable lines of business.
  • Designs and maintains tracking and reporting mechanisms to confirm encounter disposition, identify submission gaps, and drive resolution of outstanding items.
  • Establishes escalation pathways and control processes to minimize encounter submission risk and ensure regulatory deadlines are met.
  • Leads the coordination of all Risk Adjustment Data Validation (RADV) activities, including internal audit preparation, response management to CMS audit requests, and analysis of audit findings.
  • Develops and implements strategies to improve RADV performance, reduce audit exposure, and strengthen documentation standards over time.
  • Produces and maintains comprehensive performance reporting across all risk adjustment program activities, including coding results, encounter submission rates, HCC documentation outcomes, and performance against budget expectations.
  • Coordinates with Analytics and Strategy teams to translate program data into actionable insights, opportunity identification, and prioritized improvement initiatives.
  • Supports the organization's strategic planning processes with risk adjustment performance data, forecasting inputs, and program recommendations.
  • Ensures all programs operate in full compliance with CMS regulations, state Medicaid risk adjustment guidance, and ACA Marketplace risk adjustment rules.
  • Interfaces proactively with the internal Compliance function to surface program risks, policy gaps, and emerging regulatory changes requiring operational response.
  • Leads cross-functional policy development efforts and serve as the authoritative internal voice on risk adjustment regulatory requirements and standards.
  • Owns the full vendor management lifecycle for all risk adjustment vendors, including IHA overflow providers, coding vendors, and chart retrieval partners. Establishes vendor service level agreements, performance scorecards, and governance structures to ensure quality, accountability, and value delivery.
  • Conducts regular vendor performance reviews and drives continuous improvement through structured feedback, remediation planning, and, where appropriate, contract renegotiation or vendor transition.
  • Leads re-engineering efforts for key workflows including clinical data acquisition, chart retrieval, coding quality review, and encounter submission pipelines.
  • Applies structured operational improvement methodologies to eliminate process gaps, reduce rework, and improve program outcomes across lines of business.
  • Develops and sustains a high-performance team, dedicated to best-in-class solutions; responsible for attracting, developing, and retaining top-tier talent to support strategy and long-term business objectives.

Required Qualifications
  • At least 12 years of progressive experience in risk adjustment within a managed care or health plan environment, with direct accountability for program performance, or equivalent combination of relevant education and experience.
  • At least 7 years of management/leadership experience.
  • Demonstrated experience managing risk adjustment programs across multiple lines of business, including Medicare Advantage; Medicaid and Marketplace experience strongly preferred.
  • Comprehensive knowledge of Centers for Medicare and Medicaid Services (CMS) Hierarchical Condition Category (HCC) risk adjustment methodology, Medicaid risk adjustment frameworks, Marketplace risk adjustment program requirements, and Risk Adjustment Data Validation (RADV) audit processes.
  • Experience overseeing clinical data acquisition operations, chart review programs, and in-home or in-office assessment programs.
  • Proven ability to lead multi-vendor ecosystems and cross-functional programs in a complex, matrixed organizational environment.
  • Strong analytical acumen with demonstrated capability to interpret risk adjustment performance data, identify trends, and drive data-informed decision making.
  • Proven ability to collaborate and drive/influence large-scale organizational change and initiatives with internal/external stakeholders, including providers.
  • Experience developing and enforcing risk adjustment policies, coding standards, and compliance frameworks.
  • Excellent communication and influencing skills; proven ability to engage and align senior stakeholders across clinical, operational, and administrative functions.
  • Microsoft Office suite and applicable software programs proficiency, and ability to learn new information systems and software programs.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

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About Molina Healthcare

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Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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