Your Future is our Future

At Lumeris, we believe that our greatest achievements are made possible by the talent and commitment of our team members. That's why we are actively seeking talented and collaborative individuals who are passionate about making a difference in the healthcare industry. Join us today as we strive to create a system of care that every doctor wants for their own family and become part of a community that values its people and empowers you to make an impact.

Position:

Vice President, Risk Adjustment (Essence Healthcare)

Position Summary:

The Vice President of Risk Adjustment provides enterprise leadership and accountability for Medicare Advantage Risk Adjustment across Essence Healthcare. This executive role is responsible for developing and executing the long-term strategy that ensures accurate risk capture, disciplined compliance, and operational excellence in a highly regulated CMS environment.

The selected leader will shape the structure, rigor, and governance of the Risk Adjustment function while strengthening provider engagement, audit readiness, and performance transparency across the organization.

The VP establishes and executes a 3–5 year functional strategy and leads the Risk Adjustment organization through Directors and senior leaders. This role holds decision-making authority for standards, processes, and operating practices that materially influence financial integrity, compliance posture, and member outcomes within the Medicare Advantage business.

Job Description:

What You Will Be Accountable For

Strategic Leadership & Functional Direction

• Define and execute a multi-year Medicare Advantage Risk Adjustment strategy aligned to enterprise growth and compliance objectives

• Translate strategy into annual priorities, roadmaps, and measurable execution plans

• Strengthen governance, operational discipline, and performance visibility across the function
  

CMS Compliance & Audit Readiness

• Ensure full compliance with CMS Risk Adjustment methodologies, RADV requirements, and evolving regulatory guidance

• Lead enterprise preparedness for CMS audits and regulatory reviews

• Oversee remediation strategies, documentation standards, and defensible governance structures
  

Provider Engagement & Clinical Documentation Excellence

• Partner with medical groups and clinical leadership to drive shared accountability for accurate documentation and HCC capture

• Improve workflows that support real-time, actionable information at the point of care

• Elevate documentation quality while maintaining uncompromising integrity
  

Cross-Functional Integration

• Align Risk Adjustment with Actuarial, Compliance, Product, Clinical Operations, Quality, Pharmacy, and Network teams

• Resolve cross-functional trade-offs impacting RAF performance and encounter completeness

• Ensure consistent executive alignment on performance, exposure, and strategic direction
  

Performance Optimization & Analytics

• Establish and monitor KPIs including RAF accuracy, encounter submission completeness, provider engagement, and documentation quality

• Leverage data insights to drive continuous improvement and resource prioritization

• Inform investment decisions tied to revenue integrity and operational efficiency
  

Technology & Innovation

• Partner with technology and product teams to advance Risk Adjustment platforms, HCC coding tools, and encounter data workflows

• Evaluate and enhance tools that improve scalability, transparency, and provider adoption

• Serve as executive sponsor for Risk Adjustment technology initiatives
  

Organizational & Financial Stewardship

• Lead and develop a high-performing team through Directors and managers

• Foster a culture of accountability, collaboration, and continuous improvement

• Own the Risk Adjustment budget, including staffing, vendor partnerships, and technology investments
  
  Qualifications:

• Bachelor’s Degree in Health Administration, Business Administration, or a related field

• 15+ years of relevant experience

• 7+ years of leadership experience within the healthcare sector

• 7+ years of relevant experience directly tied to Risk Adjustment and documentation and coding accuracy solutions

• Extensive experience in payer, hospital, Medicaid/Medicare, provider environment, or managed care settings

• Proven ability to influence and lead cross-functional teams in a complex, matrixed environment

• In-depth knowledge of Risk Adjustment Payment methodologies and the CMS HCC Model

• Strong organizational, analytical, and communication skills

• Demonstrated commitment to best practices, continuous process improvement, and effective change management

• Ability to travel up to 50%
  
  Preferred:

• Experience in Commercial Risk Adjustment

• Experience with ACO REACH Risk Adjustment

• Coding Certification (e.g., CPC or CRC)

• Master’s Degree in a related field

• 7+ years of leadership experience within the healthcare sector

• 7+ years of relevant experience directly tied to Risk Adjustment and documentation and coding accuracy solutions

• Extensive experience in payer, hospital, Medicaid/Medicare, provider environment, or managed care settings

• Proven ability to influence and lead cross-functional teams in a complex, matrixed environment

• In-depth knowledge of Risk Adjustment Payment methodologies and the CMS HCC Model

• Strong organizational, analytical, and communication skills

• Demonstrated commitment to best practices, continuous process improvement, and effective change management

• Ability to travel up to 50%

Pay Transparency:

Factors that may be used to determine your actual pay rate include your specific skills, experience, qualifications, location, and comparison to other employees already in this role. In addition to the base salary, certain roles may qualify for a performance-based incentive and/or equity, with eligibility depending on the position. These rewards are based on a combination of company performance and individual achievements.

The hiring range for this position is:

$175,300.00-$249,100.00

Benefits of working at Lumeris

• Medical, Vision and Dental Plans

• Tax-Advantage Savings Accounts (FSA & HSA)

• Life Insurance and Disability Insurance

• Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days)

• Employee Assistance Program

• 401k with company match

• Employee Resource Groups

• Employee Discount Program

• Learning and Development Opportunities

• And much more...

Be part of a team that is changing healthcare!

Member Facing Position:

No- Not Member or Patient Facing Position

Location:

Remote, USA

Time Type:

Full time

Lumeris and its partners are committed to protecting our high-risk members & prospects when conducting business in-person. All personnel who interact with at-risk members or prospects are required to have completed, at a minimum, the initial series of an approved COVID-19 vaccine. If this role has been identified as member-facing, proof of vaccination will be required as a condition of employment.

Disclaimer:

• The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individual with disabilities to perform the essential job duties and responsibilities.

Lumeris is an EEO/AA employer M/F/V/D.