Director, Risk Adjustment Coding

Alpine Physicians•Usa, CA

1d•$103,480 - $147,826

About The Position

About Alpine Physician Partners Alpine Physician Partners is dedicated to empowering physicians with the tools, insights, and support needed to deliver high‑quality, value‑based care. Through data-driven solutions, strong clinical partnerships, and innovative operational models, Alpine helps practices succeed in risk‑based arrangements while improving outcomes for their patients. Position Summary The Director, Risk Adjustment Coding is responsible for the strategy, leadership, and operational excellence of Alpine’s risk adjustment coding programs across all markets and provider groups. This leader oversees coding accuracy, documentation improvement initiatives, vendor relationships, technology implementation, and compliance with CMS and payer‑specific risk adjustment guidelines. The ideal candidate is a seasoned leader with deep expertise in HCC coding, Medicare Advantage, value‑based care, and physician‑centric operational models—capable of building scalable programs that drive clinical quality, financial accuracy, and provider satisfaction.

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.

Nice To Haves

Experience in a physician enablement, MSO, or value‑based care organization.
Background in analytics-driven or technology-enabled coding programs.
Bachelor's degree in healthcare administration, nursing, HIM, or related field.
Ability to thrive in a fast-paced, growing, entrepreneurial environment.

Responsibilities

Strategic Leadership 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.
Operational Excellence 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.
Provider Engagement & Education 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.
Technology & Data Enablement 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.
Ensure coding programs integrate seamlessly with clinical workflows and value-based care operations.
Compliance & Quality Assurance 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.
Ensure coding standards meet or exceed industry benchmarks for accuracy and compliance.
Team Leadership & Development 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.