Director, Risk Adjustment

Interwell Health

20h•Remote

About The Position

Interwell Health is a kidney care management company that partners with physicians on its mission to reimagine healthcare—with the expertise, scale, compassion, and vision to set the standard for the industry and help patients live their best lives. We are on a mission to help people and we know the work we do changes their lives. If there is a better way, we will create it. So, if our mission speaks to you, join us! What You’ll Do The Director of Risk Adjustment is a strategic operational leader responsible for driving risk adjustment performance across Interwell Health’s payer and government programs. The Director will serve as a central leader in advancing Interwell’ s risk adjustment capabilities, with accountability for both execution and measurable results in a highly regulated environment. The Director will translate organizational strategy into scalable programs and support cross-functional teams across clinical, coding, analytics, and provider engagement. As the Director of Risk Adjustment, you will provide operational support, driving day-to-day operations, implementing new pilots, and running existing programs. In this role, you will play a critical part in assessing the opportunity for performance improvement, devising the approach for implementation of new strategies, and managing deployment of performance related initiatives for Nephrology providers.

Requirements

8–12+ years of experience in risk adjustment, healthcare operations, or related field
Deep expertise in Medicare Advantage risk adjustment, HCC coding, and RAF methodology
Experience leading enterprise or multi-market risk adjustment programs (MA, CKCC, Commercial preferred)
Proven ability to translate strategy into execution and measurable outcomes
Strong financial acumen with ability to connect RAF performance to revenue impact
Demonstrated success leading cross-functional initiatives in complex healthcare environments
Experience building and leading high-performing teams

Nice To Haves

Bachelor’s degree in related field of study

Responsibilities

Lead the development and execution of enterprise-wide risk adjustment strategy aligned to clinical, operational, and financial priorities
Translate organizational goals (e.g., RAF improvement, recapture performance, coding accuracy) into actionable, scalable programs
Partner with executive leadership to align risk adjustment priorities across Medicare Advantage, CKCC, and commercial populations
Drive innovation and continuous improvement through advanced analytics, AI/NLP, and point-of-care enablement
This role is accountable for designing and executing a comprehensive risk adjustment strategy anchored in three core pillars:
Patient-Level Tracking: Build and operationalize longitudinal tracking of all suspected and recaptured conditions at the patient level—creating enterprise visibility comparable to medical cost tracking and enabling proactive management of coding gaps
Data Enrichment: Leverage analytics, predictive modeling, and external vendor partnerships to enhance suspecting logic, improve data completeness, and increase targeting precision
Execution Beyond Nephrology: Expand risk adjustment execution beyond nephrology by developing scalable processes to engage primary care providers (PCPs), health plans, and in-home programs to ensure comprehensive gap closure across the full continuum of care
Establish KPIs, dashboards, and reporting cadences to ensure transparency and accountability
Translate performance into financial impact (e.g., PMPM, revenue lift) for executive and board-level communication
Identify risks to performance and implement mitigation strategies.
Own and drive performance against key risk adjustment metrics, including:
RAF accuracy and trend performance
Recapture rates and gap closure
Coding accuracy and audit outcome
Serve as a central leader across clinical operations, analytics, product, compliance, and finance
Partner with analytics teams to refine suspecting models and performance measurement
Collaborate with clinical and provider-facing teams to embed risk adjustment into workflows at the point of care
Influence product and technology roadmaps (e.g., Epic integration, documentation tools)
Lead and develop a high-performing team responsible for risk adjustment operations and delivery
Establish clear goals, accountability, and performance expectations aligned with enterprise priorities
Foster a culture of ownership, continuous improvement, and compliance
Ensure all risk adjustment activities meet CMS, payer, and regulatory requirements
Partner with compliance to mitigate risk and maintain coding integrity
Promote a culture of accurate, ethical, and defensible documentation