Senior Group Risk Specialist providing risk management expertise to business leaders at TD Bank. Leading risk frameworks and providing expert advice to senior management within the organization.
About the role
- Director of Risk Adjustment Coding responsible for overseeing coding programs and compliance in a healthcare organization. Leading strategies for documentation improvement and team management.
Responsibilities
- Develop and execute Alpine’s enterprise-wide risk adjustment coding strategy aligned with organizational value-based care goals
- Design scalable frameworks for HCC coding operations, documentation improvement, and provider education across diverse care settings
- Partner with executive leadership to forecast, plan, and evaluate annual risk adjustment performance
- Lead day-to-day management of coding operations, including in-house coders, vendors, chart retrieval processes, and auditing
- Oversee timely and accurate capture of HCCs for MA, MSSP, and ACO Reach risk programs
- Implement processes that improve provider documentation completeness and clinical accuracy
- Collaborate closely with physicians, practice leaders, and clinical teams to drive documentation improvement
- Build and deliver education programs, coaching, and workflow enhancements that reduce burden and elevate documentation quality
- Serve as the go-to expert for coding issues, regulatory guidance, and clinical documentation best practices
- Partner with data/analytics teams to enhance risk adjustment dashboards, reporting, and EMR-driven coding solutions
- Evaluate and manage technology solutions that support prospective and retrospective coding workflows
- Maintain strict adherence to CMS, HHS, OIG, and payer-specific risk adjustment policies
- Lead internal and external audit programs, including RADV preparedness, vendor monitoring, and coding quality assurance
- Recruit, develop, and retain a high-performing team of coders, auditors, educators, and analysts
- Foster a culture of accountability, service excellence, and continuous improvement
- Manage budgets, resource allocation, and operational KPIs
Requirements
- 7+ years of experience in risk adjustment coding leadership within MA, ACO, or other risk-based programs
- Expert knowledge of HCC models (CMS-HCC) and RAF methodologies
- Relevant coding certifications (e.g., CRC, CPC, CCS)
- Proven success in leading large-scale coding teams and vendor relationships
- Experience working closely with physicians and clinical teams
- Deep understanding of CMS guidelines, compliance requirements, and audit processes
Benefits
- Mission-driven organization supporting independent physicians
- Opportunity to build and scale a best-in-class risk adjustment program
- Collaborative, innovative, growth-oriented environment
- Direct impact on patient outcomes and provider success
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