Lightbeam Health Solutions ยท 5 months ago
Director of Risk Adjustment and Quality
Dallas, TX
Full-time
Onsite
Director/Executive
8+ years expLightbeam Health Solutions is focused on improving healthcare outcomes through their SaaS platform. The Director of Risk Adjustment and Quality will lead the strategy and execution of risk adjustment and quality initiatives, ensuring compliance and supporting clients' financial performance goals.
ConsultingHealth CareInformation Technology
Responsibilities
Own the risk adjustment and quality product roadmap for Medicare Advantage, provider organizations, and commercial payer clients
Lead the development of HCC coding, suspecting, recapture tracking, and gap closure modules within the platform
Oversee analytics, reporting, and client enablement programs focused on risk adjustment accuracy and quality measure performance (HEDIS, STAR Ratings, CAHPS, etc.)
Ensure compliance with CMS guidelines, NCQA standards, and other regulatory requirements specific to Medicare Advantage and commercial risk programs
Partner with Product, Engineering, and Data Science teams to deliver scalable, high-performing SaaS solutions supporting MA plans, provider groups, and health plans
Work directly with client leadership teams to translate regulatory and business requirements into actionable platform configurations and reporting strategies
Provide subject matter expertise on CMS file formats (BCDA, CCLF, EDGE) and value-based care models including ACO REACH, MSSP, and commercial risk arrangements
Lead internal teams including clinical coders, quality analysts, and client success staff focused on risk and quality performance improvement
Analyze and report on key KPIs including RAF score accuracy, gap closure rates, and STAR metric performance, driving continuous improvement strategies
Monitor industry trends, regulatory updates, and competitor activity to inform product and business strategy
Qualification
Required
Bachelor's degree in Healthcare Administration, Public Health, Data Science, or a related field; Master's preferred
8+ years of experience in Medicare Advantage, risk adjustment, and quality improvement within a payer, provider, or SaaS environment
Proven leadership experience overseeing risk adjustment and quality programs, including team management and cross-functional collaboration
Deep understanding of Medicare Advantage program requirements, including HCC coding, STAR ratings, HEDIS measures, CAHPS, and VBP models
Experience with payer-provider collaboration and managing risk programs across different organizational structures
Familiarity with healthcare data formats: FHIR, HL7, BCDA, CCLF, EDGE files, and claims data
Exceptional communication, client-facing, and presentation skills
Preferred
Certified Risk Adjustment Coder (CRC) or Certified Professional Coder (CPC)
Experience deploying AI or machine learning solutions for risk adjustment or quality gap closure
Strong understanding of data integration workflows supporting payers, providers, and Medicare Advantage plans
Company
Lightbeam Health Solutions
Lightbeam provides the efficiency necessary to achieve superior outcomes while mitigating burnout.
201-500 employees
Funding
Current Stage
Growth StageTotal Funding
unknown2016-02-24Series Unknown
2014-09-01Series A
Leadership Team
Michael Hoxter
Chief Technology Officer
Kent Locklear, MD MBA
Chief Medical Officer
Recent News
2025-12-10
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