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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 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

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