Director of Risk Adjustment

Company: The Judge Group
Location: Vista
Posted on: June 20, 2022

Job Description:

Location: Vista, CA Description: Our client is currently seeking a Director of Risk Adjustment located in Vista, CA. This job will have the following responsibilities:

• Correlates HCC activities, HCC Project Plan, & HCC results to evaluate outcomes.
• Gains insight to internal physician group HCC activities and incorporate into HCC - project plan.
• Train all HCC activities for all assigned physician groups and insure that all tasks are completed in a timely manner.
• Works jointly with senior Health Plan teams to evaluate training tools and ensure appropriate training of physicians is in place.
• Manages assigned department staff ensuring timely and accurate completion of tasks.
• Works jointly with Encounter Data Team to ensure accurate encounter data transmission processes exist for all groups and their affiliates capitated hospitals. - Provided solutions to any issues identified in the encounter data process in order to minimize or eliminate any negative impact to HCC results.
• Review members' medical records in the Physician, Specialist, and Inpatient facility office for additional HCC's not submitted by provider group.
• Takes initiative and is creative an innovative in solving or recommending ways to solve problems and issues. Qualifications & Requirements:
  • Minimum of five (5) years' experience in working with health care data such as claims, encounter data, and/or coding.
  • Certified Coder or coding experience required.
  • Understanding of Risk Adjustment model and HCCs.
  • Excellent analytical skills as it relates to health care data
  • Strong management, organization, and decision making skills If you are interested please contact Ricki Hoffman at 720-463-3580 or email your resume to ehoffman@judge.com. Contact: This job and many more are available through The Judge Group. Find us on the web at

Keywords: The Judge Group, Vista , Director of Risk Adjustment, Executive , Vista, California