Sr. Director, Risk Adjustment (0778)

Cinqcare • Washington, WA

2d • Onsite

About The Position

The Sr. Director of Risk Adjustment is a senior leader responsible for designing, executing, and continuously improving CINQCARE's enterprise-wide risk adjustment strategy. This data science-forward role leverages advanced analytics, machine learning, and predictive modeling to maximize risk score accuracy, optimize reimbursement, and drive population health outcomes across Medicare Advantage, Medicaid Managed Care, and ACO REACH programs. The Sr. Director will lead a multidisciplinary team of analysts, data scientists, and program specialists while partnering closely with clinical, finance, and technology leadership.

Requirements

• Master's or doctoral degree in Data Science, Biostatistics, Health Informatics, Mathematics, or a closely related quantitative field.
• 10+ years of progressive experience in risk adjustment, with at least 3 years in a senior leadership role.
• Deep expertise in CMS-HCC, HHS-HCC, and CDPS risk adjustment models.
• Advanced proficiency in Python and/or R for statistical modeling, machine learning, and large-scale data analysis.
• Strong command of SQL and experience working with claims, encounter, and clinical datasets in cloud or on-premises data environments (e.g., Snowflake, Databricks, Redshift).
• Demonstrated experience building and deploying predictive models in a healthcare payer or provider setting.
• Proven ability to lead and develop high-performing, cross-functional teams.
• Exceptional executive communication and data storytelling skills.

Nice To Haves

• Experience in value-based care, ACO, or managed care organizations
• Certified Risk Adjustment Coder (CRC) or similar credential is a plus.
• Familiarity with NLP/text mining techniques applied to clinical documentation
• Experience with BI platforms (Power BI, Tableau) and data visualization best practices

Responsibilities

• Develop and own the enterprise risk adjustment analytics strategy, roadmap, and governance framework across all lines of business including Medicare Advantage, Medicaid Managed Care, and ACO REACH.
• Lead a team of data scientists, senior analysts, and program staff; set vision, define priorities, and foster a high-performance analytics culture.
• Build and deploy predictive models (e.g., HCC suspecting, gap closure prioritization, RAF trajectory forecasting) using Python, R, or equivalent tools.
• Oversee end-to-end data pipeline design including claims data ingestion, encounter data reconciliation, and integration with EMR/EHR platforms.
• Translate complex data science outputs into actionable clinical and operational insights for executive leadership, clinical teams, and provider partners.
• Direct retrospective and prospective chart review programs; manage vendor relationships and performance against contractual KPIs.
• Establish and maintain a comprehensive analytics infrastructure for HCC performance monitoring, coding completeness, and audit-readiness dashboards.
• Partner with Finance to quantify risk adjustment revenue impact and build multi-year financial forecasting models.
• Serve as the subject matter expert on CMS-HCC, HHS-HCC, and CDPS models; monitor regulatory changes and adjust strategy proactively.
• Champion clinical documentation improvement (CDI) initiatives in collaboration with clinical and provider engagement teams.
• Present risk adjustment performance, trends, and strategic recommendations to C-suite and Board-level stakeholders.
• Ensure all programs are compliant with CMS guidelines, ICD-10 coding standards, and organizational policies.

Benefits

• Medical Plans: Two comprehensive options offered to Team members.
• 401K: 4% employer match for your future.
• Dental & Vision: Flexible plans with in-network savings.
• Paid Time Off: Generous PTO, holidays, and wellness time.
• Pet insurance, commuter benefits, mileage reimbursement, CME for providers, and company-provided phones for field staff.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior