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Position:Vice President, Risk Adjustment Solutions and Strategy

Position Summary:The Vice President of Risk Adjustment Solutions and Strategy provides direction and oversight for developing, implementing, and ensuring the successful execution of Risk Adjustment solutions across all clients and multiple lines of business within the organization. As a subject matter expert in Risk Adjustment, documentation, and coding, this role is pivotal in driving program maintenance, compliance, and performance measurement. The VP holds full autonomy over the cultivation and approval of guidelines, processes, procedures, and policies across multiple functional areas, significantly contributing to the company's growth and success.

Job Description:

Primary Responsibilities:

Strategic Vision and Leadership: Develops and communicates a comprehensive strategic vision for Risk Adjustment Solutions that aligns with the company’s overall goals. Provides thought leadership and strategic direction to drive innovation and competitive advantage.Executive Influence: Acts as a trusted advisor to the executive leadership team, offering strategic insights and recommendations based on industry trends, performance metrics, and company objectives. Ensures executive alignment and buy-in for key initiatives.Cross-Functional Collaboration: Leads cross-functional collaboration efforts, working closely with internal and external stakeholders to align Risk Adjustment strategies with broader organizational goals. Facilitates strong partnerships to drive successful outcomes.Innovation and Growth: Identifies and leverages new opportunities for growth and innovation in Risk Adjustment and documentation and coding accuracy. Champions the development and implementation of cutting-edge solutions and tools to enhance the accuracy and adoption of risk adjustment processes.Compliance and Governance: Ensures the organization’s Risk Adjustment programs comply with all applicable laws, regulations, and standards. Oversees the development of robust compliance frameworks and governance structures.Performance Optimization: Establishes and monitors key performance indicators (KPIs) to measure the success of Risk Adjustment initiatives. Utilizes data-driven insights to drive continuous improvement and optimize program performance.Leadership Development: Cultivates a high-performing team by providing strategic guidance, mentorship, and development opportunities. Fosters a culture of accountability, collaboration, and innovation within the Risk Adjustment team.Financial Stewardship: Oversees budgeting and financial management for Risk Adjustment programs, ensuring efficient resource allocation and maximizing ROI. Identifies opportunities for cost savings and revenue enhancement.Technological Advancement: Partners with technology and product teams to drive the development of advanced Risk Adjustment solutions. Ensures the integration of innovative technologies that enhance program effectiveness and scalability.

Qualifications:

Bachelor’s Degree in Health Administration, Business Administration, or a related field15+ years of relevant experience7+ years of leadership experience within the healthcare sector7+ years of relevant experience directly tied to Risk Adjustment and documentation and coding accuracy solutionsExtensive experience in payer, hospital, Medicaid/Medicare, provider environment, or managed care settingsProven ability to influence and lead cross-functional teams in a complex, matrixed environmentIn-depth knowledge of Risk Adjustment Payment methodologies and the CMS HCC ModelStrong organizational, analytical, and communication skillsDemonstrated commitment to best practices, continuous process improvement, and effective change managementAbility to travel up to 50%

Preferred:

Experience in Commercial Risk AdjustmentExperience with ACO REACH Risk AdjustmentCoding Certification (e.g., CPC or CRC)Master’s Degree in a related field

Working Conditions

While performing the duties of this job, the employee works in normal office working conditions.

Disclaimer

The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.

#LI-Remote

Lumeris is an EEO/AA employer M/F/V/D.

The hiring range for this position is:

$175,300.00-$249,100.00

Factors that may be used to determine your actual pay rate include your specific skills, experience, qualifications, location, and comparison to other employees already in this role. This role may also be eligible for incentive compensation. At Lumeris, we are committed to providing a total rewards package that supports your overall well-being. Our benefits include medical, vision, dental, well-being programs, 401(k) with company matching, life insurance, paid time off including paid leave, and so much more. Learn more by visiting our Careers Page.

Member Facing Position: No- Not Member or Patient Facing Position

Location:United States

Time Type:Full time

Lumeris and its partners are committed to protecting our high-risk members & prospects when conducting business in-person. All personnel who interact with at-risk members or prospects are required to have completed, at a minimum, the initial series of an approved COVID-19 vaccine. If this role has been identified as member-facing, proof of vaccination will be required as a condition of employment.