Head of Risk Adjustment/Coding Operations

Oasis Health Partners•Chicago, IL

1d•$200,000 - $250,000•Remote

About The Position

As Head of Risk Adjustment/Coding Operations, you will be accountable for the strategy, design and performance of Oasis’s risk adjustment program. This role owns the end-to-end operating model, including program structure, coding operations, compliance, performance management and cross-functional alignment. You will lead a team of coding professionals and work closely with Central Operations, Quality, Data, Clinical and Market leaders to ensure risk adjustment activities are integrated with enterprise priorities and designed for scalability and sustainability. This role plays a central part in shaping how Oasis deploys risk adjustment capabilities across markets and health plans in a way that is scalable, compliant, and aligned with provider partnerships.

Requirements

Bachelor’s degree in healthcare administration, public health, business administration, or related field
CRC, CPC, CPMA, or equivalent certifications
10+ years experience in Medicare Advantage risk adjustment, with deep expertise in HCC coding, RAF methodologies, and CMS requirements
7+ years of experience leading certified coding teams with accountability for performance outcomes
Demonstrated experience evolving risk adjustment programs in dynamic or growing organizations
Working knowledge of V28 rules and regulations and applications
Excellent leadership, communication, and interpersonal skills, with the ability to collaborate effectively with cross-functional teams
Comfortable in ambiguous, fast-paced roles with a focus on change management and continuous improvement (Start-Up experience a plus).
Candidates must be authorized to work in the United States without a current or future visa sponsorship.
This role is open to applicants currently residing in the United States.

Nice To Haves

Start-Up experience a plus

Responsibilities

Define and execute the enterprise risk adjustment strategy in partnership with cross-functional leaders, ensuring alignment with organizational objectives, payer requirements, and regulatory standards.
Design and oversee risk adjustment programs that balance retrospective and prospective approaches, informed by performance data, operational feasibility, and provider experience.
Lead coding operations, including staffing models, workflows, training, quality assurance, and performance management, with a focus on consistency and scalability.
Establish performance metrics, reporting, and feedback mechanisms that connect risk adjustment activity to outcomes and value, and inform ongoing prioritization.
Partner with Clinical and Market leaders to support effective, right-sized provider education and engagement related to documentation and coding.
Collaborate with Data and Technology teams to leverage analytics, automation, and tools that improve efficiency and decision-making across the risk adjustment lifecycle.
Develop and mentor the risk coding team, fostering accountability and continuous improvement.
Ensure compliance with CMS regulations, coding guidelines, and documentation standards, maintaining strong audit readiness and risk controls.