Oasis Health Partners® · 1 day ago
Head of Risk Adjustment/Coding Operations
United States
Full-time
Remote
Director/Executive
$200K/yr - $250K/yr
10+ years expOasis Health Partners is building healthier communities by advancing primary care. As the Head of Risk Adjustment/Coding Operations, you will be accountable for designing and executing the risk adjustment strategy, leading coding operations, and ensuring compliance and performance management across the organization.
Responsibilities
Define and execute the enterprise risk adjustment strategy in partnership with cross-functional leaders, ensuring alignment with organizational objectives, payer requirements, and regulatory standards. Design and oversee risk adjustment programs that balance retrospective and prospective approaches, informed by performance data, operational feasibility, and provider experience
Lead coding operations, including staffing models, workflows, training, quality assurance, and performance management, with a focus on consistency and scalability
Establish performance metrics, reporting, and feedback mechanisms that connect risk adjustment activity to outcomes and value, and inform ongoing prioritization
Partner with Clinical and Market leaders to support effective, right-sized provider education and engagement related to documentation and coding
Collaborate with Data and Technology teams to leverage analytics, automation, and tools that improve efficiency and decision-making across the risk adjustment lifecycle
Develop and mentor the risk coding team, fostering accountability and continuous improvement
Ensure compliance with CMS regulations, coding guidelines, and documentation standards, maintaining strong audit readiness and risk controls
Evaluate and implement a best-in-class NLP solution to maximize efficiency in our coding programs
Develop and maximize our Coding Education Platform to provide a tiered to solution for our provider partners
Partner with all signed health plans to establish a retrospective review process, inclusive of chart retrieval, chart review and provider education
Establish ASM Prospective solutions to capture value from our day-to-day coding process and reduce the administrative burden of chart collection at End Of Year
Implement solutions to align chart collection to enhance our efficiency and remove administrative impact
Establish clear reporting and governance to monitor impact, guide prioritization, and support ongoing optimization of risk adjustment efforts
Qualification
Required
Bachelor's degree in healthcare administration, public health, business administration, or related field
CRC, CPC, CPMA, or equivalent certifications
10+ years experience in Medicare Advantage risk adjustment, with deep expertise in HCC coding, RAF methodologies, and CMS requirements
7+ years of experience leading certified coding teams with accountability for performance outcomes
Demonstrated experience evolving risk adjustment programs in dynamic or growing organizations
Working knowledge of V28 rules and regulations and applications
Excellent leadership, communication, and interpersonal skills, with the ability to collaborate effectively with cross-functional teams
Comfortable in ambiguous, fast-paced roles with a focus on change management and continuous improvement (Start-Up experience a plus)
Candidates must be authorized to work in the United States without a current or future visa sponsorship
Benefits
401K
Medical
Dental
Vision
Generous time off plans
Company
Oasis Health Partners®
Oasis Health® is a value-based healthcare organization focused on building healthier communities by advancing primary care.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Andrew Hayek
Co-Founder & Board Director
Cory Roberts
Co-Founder and Board Director
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