Regional Director, Burden of Illness Operations
About The Position
The Director develops and leads strategies to ensure accurate and complete representation of patient disease burden through compliant clinical documentation and risk adjustment practices. The role uses data and performance trends to identify opportunities, establish organizational and practice-level priorities, and develop programs to improve documentation, coding accuracy, condition recapture, prevalence, and value-based care outcomes. The Director leads a team and translates Burden of Illness (BOI) strategy into actionable initiatives within physician practices. The role collaborates with providers and leaders across Risk Adjustment, Population Health, Practice Operations, Quality, Finance, Analytics, and Clinical Operations to ensure BOI initiatives are coordinated, compliant, measurable, and successfully implemented.
Requirements
- Minimum of 7 years of progressive experience in Medicare Risk Adjustment, Burden of Illness, population health, or related healthcare operations.
- Minimum of 3–5 years of leadership experience.
- Strong experience with CMS-HCC Risk Adjustment methodologies and reporting requirements.
- Experience working with physician practices and provider leadership.
- Experience with Medicare Advantage and value-based care arrangements is required.
- Demonstrated experience using healthcare data to identify opportunities and drive measurable performance improvement.
- Expert knowledge of Risk Adjustment and Burden of Illness principles.
- Strong understanding of compliant clinical documentation and coding practices.
- Strong analytical and data interpretation skills.
- Ability to translate complex performance data into actionable strategies.
- Strong provider engagement and physician relationship skills.
- Ability to lead through influence across clinical and operational teams.
- Strong executive communication and presentation skills.
- Strategic planning and program development capabilities.
- Strong problem-solving and decision-making skills.
- Ability to manage multiple complex initiatives simultaneously.
- Strong leadership and team development capabilities.
- Ability to translate strategic objectives into measurable operational execution.
Nice To Haves
- Bachelor’s degree in Healthcare Administration, Business Administration, Health Information Management, or Public Health; an equivalent combination of education and relevant professional experience may be considered.
- Active CRC or CPC certification is strongly preferred.
- Experience with ACO and risk-bearing arrangements is preferred.
- Experience with analytical and reporting tools such as Excel, SQL, Tableau, Power BI, or similar platforms is preferred.
Responsibilities
- Provide leadership and subject matter expertise for organizational Burden of Illness initiatives.
- Maintain knowledge of CMS-HCC methodologies, regulatory requirements, coding guidelines, and changes affecting BOI performance.
- Monitor key BOI indicators and identify patterns in documentation and coding performance that require provider or practice intervention.
- Ensure provider education strategies address identified documentation and coding opportunities.
- Establish BOI priorities for physician practices based on performance data and identified opportunities.
- Develop the framework teams use to execute BOI initiatives within practices.
- Segment and prioritize practices and providers based on the level of support required.
- Monitor practice and provider progress against established BOI goals.
- Identify systemic barriers affecting practice execution and coordinate solutions across the organization.
- Develop scalable workflows that integrate BOI activities into routine practice operations.
- Coordinate practice-facing BOI activities to minimize disruption and improve provider engagement.
- Partner with partnership and market operations leadership to understand priorities, performance opportunities, and partner expectations related to BOI.
- Monitor BOI performance across populations and identify opportunities requiring intervention.
- Develop targeted improvement strategies based on identified performance gaps.
- Participate in performance discussions when BOI expertise or leadership is required.
- Ensure BOI initiatives are appropriately prioritized, tracked, and executed.
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What This Job Offers
Job Type
Full-time
Career Level
Director
