Director Risk Adjustment Remote

About IKS Health 

For more information, visit: www.ikshealth.com

IKS Health takes on the chores of healthcare, reducing administrative, clinical, and operational burdens so that staff can focus on their core purpose: delivering exceptional care. Combining pragmatic technology and dedicated experts, IKS enables stronger, financially sustainable enterprises. Our Care Enablement Platform delivers data-driven value and expertise across the care journey, and IKS is a partner for clinician enterprises looking to effectively scale, improve quality, and achieve cost savings through forward-thinking solutions. Founded in 2006, IKS Health’s global workforce supports large health systems across the United States.

IKS Health is transforming the way provider organizations manage the administrative and clinical complexities of care delivery. Our Care Enablement Platform blends advanced AI-powered automation with deep human expertise to relieve administrative burdens, improve clinical workflows, and drive financial sustainability; so clinicians can get back to what they do best. 

Key Responsibilities

Job Description: Director of Risk Adjustment

• Strategic Client Management: Serve as the primary operational partner for multiple external clients across medical groups, health systems, and risk-bearing entities. Serve as the trusted advisor and escalation point, lead regular performance reviews, present complex risk adjustment data, and ensure strict adherence to Service Level Agreements (SLAs).
• Team Leadership & Scalability: Directly manage a department of 70+ production coders and auditors. Lead the organizational design and hiring strategy to expand the team as the company grows into new business lines.
• Operational Excellence: Establish, monitor, and optimize department KPIs regarding coding/auditing accuracy, compliance, daily volume throughput, and turnaround times across all active risk adjustment models.
• Regulatory Alignment: Act as the internal authority on CMS-HCC coding updates, as well as future strategic expansion into commercial coding and state-specific Medicaid lines of business, ensuring all risk adjustment programs strictly adhere to current guidelines, OIG mandates, and RADV/HHS-RADV audit readiness.
• Product & Technology Collaboration: Partner cross-functionally with the Product team as the primary business stakeholder representing coding, auditing, and regulatory best practices while optimizing model performance and user experience. 

Qualifications and Expertise

Education:
BA/BS or equivalent,  preferably  in Health Information Management.

Certifications: 

• Active Certified Risk Adjustment Coder ( CRC ) is  highly preferred. 
   
• Certified Professional Medical Auditor  (CPMA), CPC, CCS, or RHIA are considered.
   
• Core Competencies:  Exceptional operational execution across a large span of control, strong analytical data-driven decision-making, and the communication skills necessary to translate highly technical coding jargon into clear requirements for technology teams and executives.

• Experience & Leadership: 9+ years of progressive experience in risk adjustment operations within a health plan, provider organization, or vendor, including 3–5 years of direct management experience over a large workforce (50+ coders and auditors).
• Subject Matter Expert: Expert-level understanding of the end-to-end CMS-HCC Medicare risk coding model, including prospective, concurrent, and retrospective coding, including EDS and RAPS.
• Multi-Line Coding Knowledge (Plus): A strong understanding or background in Medicaid and Commercial (ACA/Exchange) risk adjustment coding models is a plus.
• Product & Technical Savvy: Proven experience collaborating with software development teams, UX designers, or engineers to build or optimize AI-enabled risk coding solutions. 
• Education & Certifications:
• Active Certified Risk Adjustment Coder (CRC) is highly preferred. 
• Certified Professional Medical Auditor (CPMA), CPC, CCS, or RHIA are considered.
• Core Competencies: Exceptional operational execution across a large span of control, strong analytical data-driven decision-making, and the communication skills necessary to translate highly technical coding jargon into clear requirements for technology teams and executives.

Compensation and Benefits: The maximum annual salary range is $130,000 - $150,000 a year, determined by years of relevant experience, skills, and the specific geographical location where the work is performed. Pay is based on several factors, including but not limited to current market conditions, location, education, work experience, certifications, etc.  IKS Health offers a competitive benefits package including healthcare, 401 (k), and paid time off (all benefits are subject to eligibility requirements for full-time employees).  IKS Health is an equal opportunity employer and does not discriminate based on race, national origin, gender, gender identity, sexual orientation, protected veteran status, disability, age, or other legally protected status