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CareSignal® – Lightbeam's Deviceless Remote Patient Monitoring · 10 hours ago

Director of Risk Adjustment and Quality

Dallas, TX

Full-time

Onsite

Director/Executive

8+ years exp

CareSignal® is a company focused on deviceless remote patient monitoring, and they are seeking a Director of Risk Adjustment and Quality. This role leads the strategy and execution of risk adjustment and quality initiatives for their SaaS platform, ensuring compliance and supporting clients' financial performance goals.

Health Care

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

Risk adjustment expertiseQuality improvement experienceMedicare Advantage knowledgeHealthcare data formatsLeadership experienceClient-facing skillsData integration workflowsAI/machine learning solutionsCertified Risk Adjustment CoderCertified Professional CoderExceptional communicationPresentation skillsTeam managementCross-functional collaboration

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

CareSignal® – Lightbeam's Deviceless Remote Patient Monitoring

Lightbeam’s Deviceless Remote Patient Monitoring (RPM) solution, CareSignal, helps healthcare organizations and payers scale care management, touch more lives, and keep patients engaged.

Founded in 2016

St Louis, Missouri, USA

51-200 employees