Remote Risk Adjustment Coding Jobs in Columbus, OH

WHO WE ARE: For more than 40 years, the Ohio Association of Community Health Centers (OACHC) has advanced access to high-quality, affordable, and comprehensive health care for all Ohioans through the growth and development of Community Health Centers. OACHC supports Ohio’s Community Health Centers, the largest primary care network in the state, by serving as a trusted partner, advocate, and convener. Through strategic partnerships, policy leadership, and innovative care delivery models, OACHC works to ensure Community Health Centers remain leaders, employers, providers, and partners of choice (LEPPOC) in the healthcare system. Furthermore, the OACHC organizational values of innovation, continuous improvement, collaboration, and strategy are foundational to the success of all service lines within the organization.

PRIMARY OBJECTIVES: The Chief Value Transformation Officer serves as the executive leader responsible for advancing OACHC’s statewide value-based care strategy and overseeing the performance and growth of the Health Centers of Ohio Accountable Care Organization (ACO) and Clinically Integrated Network (CIN). This leader is accountable for the design, execution, and performance of value-based care initiatives that strengthen financial sustainability and improve population health outcomes for member Health Centers. The Chief VTO will serve as a strategic bridge between member Health Centers, payers, the Ohio Department of Medicaid (ODM), Centers for Medicare and Medicaid (CMS), consultants, legal counsel and OACHC leadership—aligning clinical, financial, and operational priorities to support successful participation in risk-based payment models in the future. The Chief VTO leads payer contracting strategy, network performance improvement, and advanced analytics while guiding a high-performing team responsible for value-based care operations. This position reports to the President and Chief Executive Officer of OACHC and works primarily on-site at OACHC headquarters in Columbus, Ohio. OACHC currently operates in a hybrid work environment (three days in office and two days remote).

QUALIFYING CHARACTERISTICS: The Chief Value Transformation Officer will play a critical role in advancing the long-term sustainability of Ohio’s Community Health Centers by strengthening payer partnerships, expanding value-based payment opportunities, and supporting innovative care delivery and financing models. This leader will work collaboratively with member Health Centers to improve clinical and financial outcomes across the statewide network. Through strategic leadership of the Health Centers of Ohio ACO and Health Centers of Ohio CIN, this role will help position OACHC and its member Health Centers as national leaders in value-based primary care and safety-net innovation. The Chief VTO will help shape the future of Community Health Centers’ payment and care delivery in Ohio by aligning policy, payer strategy, and operational innovation.

EDUCATIONAL AND EXPERIENCE REQUIREMENTS: Bachelor’s degree in healthcare administration, business, public health, or related field required; Master’s degree (MBA, MHA, MPH, MPA or related field) preferred. Minimum 15 years of progressive leadership experience in value-based care, managed care, provider networks, and/or population health. Demonstrated experience negotiating complex payer contracts and managing risk-based agreements. Experience leading high-performing teams and cross-organizational initiatives. Preference to candidates with experience working with Federally Qualified Health Centers (FQHCs), safety-net providers, or healthcare associations, as well as experience leading ACOs, CINs, or risk-bearing provider networks.

ESSENTIAL SKILLS AND ABILITIES:

• Strategic and systems thinker with the ability to operate across complex healthcare ecosystems.
• Executive negotiation and influence with strong collaborative leadership skills.
• Financial and actuarial literacy, including understanding of medical loss ratios, risk corridors, and actuarial forecasting.
• Deep understanding of risk adjustment methodologies and quality metrics (HEDIS, Stars, Medicaid quality measures).
• Experience with shared savings, downside risk, capitation, bundled payments, and other alternative payment models.
• Strong knowledge of payer contracting structures and operationalization of risk-based agreements.
• Ability to translate complex data into actionable strategies.
• Experience leading organizational change and performance improvement initiatives.
• Understanding of regulatory and policy environments shaping value-based care and payment reform.
• High level of personal accountability and ability to maintain confidentiality.
• Ability to travel within Ohio and nationally.

MAJOR RESPONSIBILITIES:

Value-Based Strategy and Network Growth

• Refine and execute a long-term value-based care strategy and implementation roadmap for the ACO and CIN as well as other initiatives such as ODM’s Comprehensive Primary Care and Comprehensive Maternal Care
• Identify and advance new value-based reimbursement opportunities including shared savings, shared risk, capitation, bundled payments advanced primary care models and diversification of payer contracting.
• Assess market dynamics, regulatory trends, and payer strategies to inform network growth and sustainability.
• Advise the CEO, ACO/CIN Boards of Managers, CIN/ACO Caucuses, and CIN Joint Operating Committee on value-based care performance, financial risk tolerance, and strategic opportunities.
• Identify opportunities to expand network participation, payer partnerships, and innovative payment models.
• Collaborate with the OACHC Chief Policy Officer to ensure strategic direction with regard to state and federal policy changes.

Payer Strategy and Contracting

• Serve as the senior executive lead for payer negotiations and value-based care partnerships.
• Lead contracting strategy across Medicare Advantage, Medicaid managed care, commercial insurance, and other value-based arrangements.
• Structure agreements that appropriately balance financial opportunity with risk mitigation.
• Develop multi-year payer engagement strategies aligned with evolving payment models.
• Cultivate and maintain executive-level payer relationships.
• Ensure compliance with contractual obligations and monitor contract performance.

Network Performance and Analytics

• Establish strategic performance metrics to measure quality, utilization, total cost of care, financial impact, and overall program effectiveness.
• Lead the implementation and strategic use of analytics to monitor quality, utilization, cost, and financial performance to align with organizational goals and payer requirements.
• Continue optimization of the Ohio Data Integration Platform (ODIP), an analytics infrastructure that integrates clinical, claims, and financial data to drive performance improvement.
• Establish actionable dashboards and key performance indicators (KPIs) for health centers.
• Promote accurate documentation and coding practices to optimize risk adjustment, attribution accuracy, and financial reconciliation.
• Translate complex data insights into strategic guidance for leadership and member organizations.

Clinical Transformation and Care Model Alignment

• Partner with member Health Centers to advance care delivery models that support success in value-based payment arrangements.
• Align with OACHC’s CMO and CQO to support Clinical Leadership and development across health centers to drive adoption of evidence-based practices and quality improvement initiatives. Support implementation of population health management strategies, care coordination, and team-based care models.
• Collaborate with OACHC CMO and CQO to ensure alignment between network strategy and front-line care delivery.

Risk Management and Contract Performance

• Establish compliance programs and governance structures to monitor financial risk, utilization trends, and contract performance across value-based arrangements.
• Support health centers in development of risk mitigation strategies including stop-loss protections, care management interventions, and financial forecasting.
• Monitor performance against quality, cost, and utilization benchmarks and implement corrective strategies when targets are at risk.
• Collaborate with finance and actuarial advisors to evaluate risk corridors, reserves, and sustainability of risk-bearing arrangements.

Network Governance and Member Engagement

• Support governance of the Health Centers of Ohio ACO and CIN in partnership with OACHC leadership, board leadership and health center executives.
• Serve as a strategic advisor to PHCs on value-based care readiness, operational, transformation, and financial performance.
• Facilitate member engagement through collaborative learning networks, performance forums, and best practice sharing.
• Ensure transparency in network performance reporting and shared savings distribution methodologies.

Financial Stewardship

• Accountable for financial performance of value-based contracts including shared savings distribution and network sustainability.
• Collaborate with leadership to manage risk pools, financial forecasting, and reserves.
• Ensure sustainable margin generation to support reinvestment in network and member services.
• Budgeting with CEO and Chief Financial Officer

Team Leadership and Organizational Development

• Lead and develop a multidisciplinary team responsible for contracting, analytics, quality improvement/practice transformation, and network operations.
• Foster a culture of innovation, collaboration, and continuous improvement.
• Build strong cross-functional alignment and collaboration across OACHC teams including integrated health, quality, policy and HCCN programs.
• Establish clear goals, accountability structures, and professional development pathways for staff.

PHYSICAL REQUIREMENTS: Ability to sit at workstation and work on a computer for extended periods. Physical ability to continuously stoop, kneel, bend, use a computer, and perform light lifting.

The above description covers the most significant duties performed but does not restrict the administration’s right to assign or reassign other reasonable duties, responsibilities, or expectations to this job at any time, with or without advance notice. The information contained in the job description is for compliance with the American with Disabilities Act and is not an exhaustive list of the duties performed for this position. Additional duties are performed by the individual currently holding this position and additional duties may be assigned.