VP, Risk Adjustment Performance

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The Vice President, Risk Adjustment Performance is the organization's most senior leader accountable for the strategy, execution, and optimization of all Risk Adjustment programs across the Medicare Advantage business — owning both the long-term vision and the day-to-day performance of the function. This executive partners closely with Clinical, Quality, Analytics, Finance, Provider Relations, and Member Experience teams to build and execute a unified Risk Adjustment strategy that maximizes revenue accuracy, ensures CMS compliance, and demonstrates the true complexity of the members the organization serves. Leading a dedicated team of managers, data analysts, and risk coders, the VP translates federal regulatory requirements, market intelligence, and data-driven insights into action — driving provider engagement, refining coding and documentation practices, and achieving measurable improvement in RAF scores, HCC accuracy, and program performance. This role is critical to the organization because Risk Adjustment is a primary driver of Medicare Advantage revenue integrity — and the VP's ability to align clinical, operational, and analytical functions around a shared performance agenda directly determines the organization's financial position and long-term competitiveness in the MA market.

Job Responsibilities:

Develop and Execute the Multi-Year Risk Adjustment Business Plan. Own the enterprise Risk Adjustment strategy — building and executing a multi-year business plan that analyzes the interrelationships of products, operations, market dynamics, and program performance to achieve sustained improvement in RAF accuracy and revenue optimization. Establish, track, and drive performance targets and KPIs across all Risk Adjustment programs, ensuring the organization moves from reactive compliance to proactive, forward-looking performance management.

Lead Provider Network Engagement for Risk Adjustment Performance. Design and execute provider engagement strategies that directly improve HCC coding accuracy, clinical documentation quality, and Risk Adjustment performance across the provider network. Build structured, trust-based relationships with provider partners — educating on coding standards, identifying gaps, and creating feedback loops that make documentation improvement sustainable and clinically meaningful rather than administratively burdensome.

Build, Lead, and Develop the Risk Adjustment Team. Direct and develop a high-performing team of managers, data analysts, and risk coders — setting clear performance expectations, fostering a culture of accountability and continuous improvement, and investing in the professional growth of every team member. Ensure the team has the tools, training, market data, and operational infrastructure needed to execute the Risk Adjustment strategy at scale across all markets.

Maintain Expert Regulatory and Competitive Intelligence. Serve as the organization's foremost authority on CMS regulations, federal legislative changes, industry trends, and best practices in Medicare Risk Adjustment — providing timely, accurate, and actionable intelligence that enables the organization to stay ahead of regulatory shifts and competitive threats. Analyze and communicate the business implications of policy changes and market dynamics to senior leadership, providing recommendations that protect and optimize the organization's Risk Adjustment posture.

Drive Cross-Functional Governance and Strategic Alignment. Lead a structured hierarchy of cross-functional steering meetings and workgroups — spanning Pharmacy, HEDIS, CAHPS, HOS, Operations, Provider Network, and Analytics — to ensure Risk Adjustment strategies are integrated into the broader Medicare performance model and that synergies across programs are identified and captured. Serve as the primary Risk Adjustment voice in enterprise strategy discussions, advocating for Medicare business interests in cross-functional initiatives and investment decisions.

Leverage Data and Analytics to Drive Performance Improvement. Partner with Analytics, Finance, and IT teams to build and maintain the data infrastructure, reporting tools, and analytical capabilities required to identify Risk Adjustment opportunities, measure program effectiveness, and inform strategic decisions at every level of the organization. Ensure Risk Adjustment performance reporting is timely, accurate, and decision-grade — and that insights translate into operational action across clinical, coding, and provider-facing programs.

Oversee Risk Adjustment Accuracy, Audit Readiness, and Compliance. Own the organization's Risk Adjustment accuracy program — including coding audits, retrospective and prospective review processes, and vendor management for external coding and audit partners. Ensure the organization maintains a state of continuous CMS audit readiness, proactively identifies and corrects coding inaccuracies, and operates all Risk Adjustment activities in strict compliance with CMS guidelines and organizational standards.

Other duties and projects not listed above

Supervisory Responsibilities:  

This role carries full people management authority over the Risk Adjustment team, which includes directors, managers, data analysts, and risk coders.

• Directly supervises Risk Adjustment management-level staff and provides oversight across the broader team through those managers
• Responsible for building and sustaining a high-performance team culture, including talent acquisition, onboarding, performance management, development planning, and retention for all direct and indirect reports

Oversees assigned staff. Responsibilities include: recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and performance management.

Job Requirements:

Experience:

Required:

• Minimum 15 years of progressive leadership experience in Medicare Advantage, with significant depth in Risk Adjustment and/or Stars — including direct accountability for program strategy, team leadership, and measurable performance outcomes
• Demonstrated experience developing and executing multi-year Risk Adjustment business plans in a health plan, managed care organization, or related Medicare Advantage entity
• Deep working knowledge of HCC coding, CMS Risk Adjustment data validation (RADV) processes, prospective and retrospective coding programs, and the regulatory requirements governing Medicare Risk Adjustment
• Proven track record of leading provider engagement strategies that produce measurable improvements in coding accuracy and documentation quality at scale
• Demonstrated experience in a highly matrixed, cross-functional environment — leading through influence as well as authority to drive aligned execution across clinical, operational, finance, and analytics teams

Preferred:

• Prior VP or above-level experience in a Medicare Advantage health plan — not just consulting or vendor engagement
• Experience leading through CMS RADV audits or federal regulatory review processes
• Background in Medicare Part D program operations and the intersection of Part D and Risk Adjustment performance
• Track record of integrating Stars, HEDIS, and Risk Adjustment programs into a unified performance model

Education:

Required:

• Bachelor's degree in Healthcare Administration, Business Administration, Finance, Public Health, or a related field; equivalent combination of education and leadership experience in Medicare Risk Adjustment will be considered

Preferred:

• Master's degree (MBA, MHA, MPH, or related graduate degree) — particularly with coursework or concentration in healthcare finance, managed care, or health policy

Training:

Required:

• Demonstrated expert-level knowledge of CMS Medicare Risk Adjustment methodology, HCC coding frameworks, and RADV audit processes — through formal training, professional certification, or extensive applied experience

Preferred:

• CPC (Certified Professional Coder) and CRC (Certified Risk Adjustment Coder) or
• CPC (Certified Professional Coder) and CDEO (Certified Documentation Expert Outpatient) or
• CPC- I (Certified Professional Coder Instructor)
• Lean, Six Sigma, or other structured performance improvement methodology
• Formal executive leadership development or continuing education aligned to Medicare policy and managed care strategy

Specialized Skills:

Required:

• Medicare Risk Adjustment Strategy and Program Leadership (Advanced): Expert-level command of the CMS Risk Adjustment model — including HCC coding frameworks, prospective and retrospective chart review programs, RADV audit methodology, and how RAF scores translate to plan revenue. Ability to design and execute a comprehensive, multi-year Risk Adjustment strategy that integrates provider engagement, coding operations, data analytics, and compliance.
• CMS Regulatory Intelligence and Compliance Expertise (Advanced): Deep, current knowledge of CMS regulations, RADV audit processes, federal legislative trends, and the operational compliance requirements governing Medicare Risk Adjustment — with the ability to rapidly assess regulatory changes and translate them into organizational action plans.
• Provider Engagement and Network Strategy (Advanced): Proven ability to design and lead provider-facing Risk Adjustment engagement strategies — including education programs, documentation feedback loops, coding accuracy initiatives, and performance tracking — that produce measurable, sustained improvement at scale.
• Risk Adjustment Data and Analytics (Advanced): Proficiency with Medicare data systems, RAF score modeling, predictive analytics, and performance reporting — including the ability to assess data from CMS, EMR systems, and internal analytics platforms to identify opportunities, measure program impact, and communicate financial and clinical implications to senior leadership.
• Financial and Business Acumen (Advanced): Strong understanding of the financial implications of Risk Adjustment performance — including the relationship between RAF accuracy, premium revenue, reserve adequacy, and margin — with the ability to build and defend business cases, financial projections, and multi-year program investment plans.
• Cross-Functional Leadership and Influence (Advanced): Demonstrated ability to lead and align diverse cross-functional teams — including Clinical, Quality, Analytics, Finance, Provider Relations, and Operations — in the execution of a shared Risk Adjustment strategy across a complex, matrixed organization.
• Team Leadership and Talent Development (Advanced): Proven ability to build, lead, and sustain a high-performing Risk Adjustment team — including management, analytics, and coding professionals — through clear expectations, active coaching, structured performance management, and a culture of continuous improvement.

Preferred:

Licensure:

Required:

• CPC (Certified Professional Coder)

Preferred:

• CPC- I (Certified Professional Coder Instructor)
• CRC (Certified Risk Adjustment Coder)
• PAHM (Professional, Academy for Healthcare Management) or equivalent managed care certification

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Pay Range: $227,952.00 - $341,928.00

Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

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