Talent.com
Director Risk Adjustment
Director Risk AdjustmentCommunityCare • Tulsa, OK, US
Director Risk Adjustment

Director Risk Adjustment

CommunityCare • Tulsa, OK, US
[job_card.variable_days_ago]
[job_preview.job_type]
  • [job_card.full_time]
[job_card.job_description]

JOB SUMMARY :

The Director of Risk Adjustment is responsible for the strategic design, implementation, and oversight of CCOK's risk adjustment program for both ACA and Medicare Advantage businesses. This individual will coordinate with various areas including IT, Healthcare Economics, Finance, and the Clinical Auditing team in order to maximize the efficiency and effectiveness of Risk Adjustment strategy, analytics, and data reporting to CMS, as well as supporting processes regarding provider education and member engagement to identify opportunities for improved accuracy in coding.

KEY RESPONISBILITIES :

  • Develop and execute enterprise-wide risk adjustment strategy to align with regulatory requirements and financial objectives
  • Oversee all aspects of risk adjustment data analytics, including CMS reporting, clinical documentation improvement strategy, and vendor management
  • Lead cross functional teams including coding, analytics, compliance, medical economics and operations to ensure seamless integration of risk adjustment initiatives
  • Monitor and ensure compliance with CMS, Oklahoma regulations, and audit requirements
  • Lead end-to-end timely and accurate submission of risk adjustment data to CMS including overseeing the reconciliation of CMS reports to validate submission accuracy
  • Translate risk adjustment performance into actionable insights to support medical management and quality initiatives
  • Drive innovation and efficiency in risk capture methodologies
  • Partner with finance, actuarial, operations teams to forecast, track performance and manage risk score impacts for all contracted products
  • Collaborate with Clinical Operations on provider education needs to ensure documentation and coding accuracy
  • Evaluate and manage relationships with third party vendors providing risk adjustment services
  • Serve as internal subject matter expert on all aspects of risk adjustment policy changes and risk scoring methodologies
  • Executive level reporting identifying actual to expected performance, outlier trends and prevalence opportunities
  • Promote a culture of accountability, innovation and compliance.
  • Performs other job-related duties as assigned.

QUALIFICATIONS :

  • Expert level knowledge of Medicare Advantage and ACA Risk Adjustment reporting lifecycle and submission systems
  • Possesses an insatiable need for process improvement and operational effectiveness
  • Excellent communication, executive presence and relationship building skills
  • Strategic thinker with excellent analytical, critical thinking, problem-solving, interpersonal, and relationship building skills.
  • Successful completion of Health Care Sanctions background check.

    • EDUCATION / EXPERIENCE :

  • Bachelor's degree in healthcare administration, data science, accounting, finance, or related field; Master's degree MBA, MHA, MPH preferred
  • 10+ years of experience in risk adjustment, Medicare Advantage or related healthcare operations
  • 6 plus years of management experience.
    • [job_alerts.create_a_job]

    Director Adjustment • Tulsa, OK, US

    [internal_linking.related_jobs]
    CDL-A Refrigerated Truck Driver in Okmulgee, OK

    CDL-A Refrigerated Truck Driver in Okmulgee, OK

    AllTruckJobs • Okmulgee, OK, US
    [job_card.full_time]
    Ready for a career upgrade? Join Marten Transport! As a stable, financially healthy carrier – and a 2025 TCA Elite Fleet honoree – we offer the best of both worlds : high miles in your region and th...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Manager

    Manager

    Chick-fil-A • Tulsa, OK, US
    [job_card.full_time] +1
    Making sure your team gets everything done.Leading and inspiring your team!.Monitoring a food safe environment.Motivating your team on the Chick-fil-A way. This is a leadership role, what were looki...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Truck Driver Team Driver - 6mo EXP Required - OTR - Dry Van - $200k per year

    Truck Driver Team Driver - 6mo EXP Required - OTR - Dry Van - $200k per year

    Big M Diesel Express • Okmulgee, OK, US
    [job_card.full_time]
    Big M Transportation is Hiring Solo & Team Company Drivers for OTR Opportunities!.Over-the-road drivers continue to be the top earners in the trucking industry, and becoming part of a team is o...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Director Of Rehab - Permanent

    Director Of Rehab - Permanent

    Central Business Solutions • Tulsa, OK, United States
    [job_card.permanent]
    The Director of Rehabilitation (DOR) at PowerBack Rehabilitation is responsible for leading a team of clinicians to provide high-quality rehabilitation services to patients.This role involves overs...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Senior Manager Process Architect

    Senior Manager Process Architect

    Cherokee Federal • Tulsa, OK, United States
    [job_card.full_time] +1
    Senior Manager Process Architect The Senior Manager Process Architect owns a multi-function value stream and the policies, controls, and standards that govern it. This role anticipates regulatory an...[show_more]
    [last_updated.last_updated_variable_hours] • [promoted] • [new]
    Remote Finance Director - AI Trainer ($50-$60 / hour)

    Remote Finance Director - AI Trainer ($50-$60 / hour)

    Data Annotation • Tulsa, Oklahoma
    [filters.remote]
    [job_card.full_time] +1
    We are looking for a finance professional to join our team to train AI models.You will measure the progress of these AI chatbots, evaluate their logic, and solve problems to improve the quality of ...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Travel RN - Director of Nursing in Owasso, Oklahoma - $3,793–$6,638 / week (Must Have 2 Years of Experience)

    Travel RN - Director of Nursing in Owasso, Oklahoma - $3,793–$6,638 / week (Must Have 2 Years of Experience)

    Vetted • Owasso, OK, United States
    [job_card.full_time]
    Vetted is seeking a RN - Director of Nursing for a travel job in Owasso, Oklahoma.Must have 2 years of experience.The assignment is 13 weeks long with 8 hour shifts. This contract pays approximately...[show_more]
    [last_updated.last_updated_less] • [promoted] • [new]
    Urology Medical Director Opportunity in Oklahoma!

    Urology Medical Director Opportunity in Oklahoma!

    HealthEcareers - Client • Tulsa, OK, USA
    [job_card.full_time]
    Job Description : One of the largest hospitals in both Oklahoma and the nation is excited to welcome a Medical Director to step into a busy, well established urology practice.You will lead and pract...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Director of Rehab (DOR)

    Director of Rehab (DOR)

    PowerBack Rehabilitation • Tulsa, OK, United States
    [job_card.full_time] +1
    Come join our team at beautiful Montereau!.At Powerback, we're on a mission to improve lives.As the leader in physical, occupational, speech, and respiratory therapies, we help older adults stay ac...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Director Of Rehab

    Director Of Rehab

    AT Staffing • Tulsa, OK, United States
    [job_card.full_time] +1
    Job # : 200314 Title : Director Of Rehab Location : Tulsa, OK Salary Range : PTA / COTA : $30-$36, PT / SLP / OT : $40-$46 Hourly Position : Director Of Rehab Description : . Our client is seeking a dynamic and ex...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Director of Rehabilitation

    Director of Rehabilitation

    Staffing Solutions United • Tulsa, OK, United States
    [job_card.full_time]
    Director of Rehabilitation (DOR).We are seeking an experienced and dedicated.Director of Rehabilitation (DOR).The DOR will oversee physical, occupational, and speech therapy programs, ensuring comp...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Outside Insurance Sales - Completed Training Required

    Outside Insurance Sales - Completed Training Required

    Platinum Supplemental Insurance • Owasso, Oklahoma
    [job_card.full_time]
    Ready to jump-start your career and take charge of your earning potential?.At Platinum Supplemental Insurance, we’re looking for motivated individuals ready to learn, grow, and thrive in a fast-pac...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Store Scanning Specialist

    Store Scanning Specialist

    RDSolutions formerly RetailData • Okmulgee, OK, US
    [job_card.part_time]
    The retail industry continues to see unprecedented dynamics as it pivots to a true omni-channel shopping experience.Informed retailers are succeeding, and RDSolutions is providing them with the con...[show_more]
    [last_updated.last_updated_variable_hours] • [promoted] • [new]
    Director of Rehab (DOR)

    Director of Rehab (DOR)

    Genesis Healthcare Services • Tulsa, OK, United States
    [job_card.full_time] +1
    Come join our team at beautiful Montereau!.At Powerback, we're on a mission to improve lives.As the leader in physical, occupational, speech, and respiratory therapies, we help older adults stay ac...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Director Risk Adjustment

    Director Risk Adjustment

    CommunityCare • Tulsa, OK, US
    [job_card.full_time]
    The Director of Risk Adjustment is responsible for the strategic design, implementation, and oversight of CCOK’s risk adjustment program for both ACA and Medicare Advantage businesses.This in...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Director, Commercial

    Director, Commercial

    Busey Bank • Tulsa, OK, United States
    [job_card.full_time]
    The Commercial Director builds a customer base through prospecting, community involvement and proactive business development activities. Increases C&I loan portfolio through sound underwriting pract...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Side Hustle Project Lead

    Side Hustle Project Lead

    Finance Buzz • Okmulgee, Oklahoma, US
    [job_card.full_time] +1
    We’re offering a role for someone who wants to lead their own side-income project in their spare time.You’ll explore various proven side hustles, select the ones that fit your lifestyle, and run th...[show_more]
    [last_updated.last_updated_30] • [promoted]
    OK427m - Adult Psychiatric Medical Director

    OK427m - Adult Psychiatric Medical Director

    Fcs Co • Tulsa, OK, United States
    [job_card.part_time]
    Adult Psychiatrist needed for Medical Director.Adult and Child experience a major plus! Prefer a background in a Community Mental Health Center (CMHC) or Certified Community Behavioral Health Clini...[show_more]
    [last_updated.last_updated_30] • [promoted]