Vice President, Risk Adjustment (Essence Healthcare)

Lumeris

20h•Remote

About The Position

At Lumeris, we believe that our greatest achievements are made possible by the talent and commitment of our team members. That's why we are actively seeking talented and collaborative individuals who are passionate about making a difference in the healthcare industry. Join us today as we strive to create a system of care that every doctor wants for their own family and become part of a community that values its people and empowers you to make an impact. Position: Vice President, Risk Adjustment (Essence Healthcare) Position Summary: The Vice President of Risk Adjustment provides enterprise leadership and accountability for Medicare Advantage Risk Adjustment across Essence Healthcare. This executive role is responsible for developing and executing the long-term strategy that ensures accurate risk capture, disciplined compliance, and operational excellence in a highly regulated CMS environment. The selected leader will shape the structure, rigor, and governance of the Risk Adjustment function while strengthening provider engagement, audit readiness, and performance transparency across the organization. The VP establishes and executes a 3–5 year functional strategy and leads the Risk Adjustment organization through Directors and senior leaders. This role holds decision-making authority for standards, processes, and operating practices that materially influence financial integrity, compliance posture, and member outcomes within the Medicare Advantage business.

Responsibilities

Strategic Leadership & Functional Direction Define and execute a multi-year Medicare Advantage Risk Adjustment strategy aligned to enterprise growth and compliance objectives Translate strategy into annual priorities, roadmaps, and measurable execution plans Strengthen governance, operational discipline, and performance visibility across the function
CMS Compliance & Audit Readiness Ensure full compliance with CMS Risk Adjustment methodologies, RADV requirements, and evolving regulatory guidance Lead enterprise preparedness for CMS audits and regulatory reviews Oversee remediation strategies, documentation standards, and defensible governance structures
Provider Engagement & Clinical Documentation Excellence Partner with medical groups and clinical leadership to drive shared accountability for accurate documentation and HCC capture Improve workflows that support real-time, actionable information at the point of care Elevate documentation quality while maintaining uncompromising integrity
Cross-Functional Integration Align Risk Adjustment with Actuarial, Compliance, Product, Clinical Operations, Quality, Pharmacy, and Network teams Resolve cross-functional trade-offs impacting RAF performance and encounter completeness Ensure consistent executive alignment on performance, exposure, and strategic direction
Performance Optimization & Analytics Establish and monitor KPIs including RAF accuracy, encounter submission completeness, provider engagement, and documentation quality Leverage data insights to drive continuous improvement and resource prioritization Inform investment decisions tied to revenue integrity and operational efficiency
Technology & Innovation Partner with technology and product teams to advance Risk Adjustment platforms, HCC coding tools, and encounter data workflows Evaluate and enhance tools that improve scalability, transparency, and provider adoption Serve as executive sponsor for Risk Adjustment technology initiatives
Organizational & Financial Stewardship Lead and develop a high-performing team through Directors and managers Foster a culture of accountability, collaboration, and continuous improvement Own the Risk Adjustment budget, including staffing, vendor partnerships, and technology investments