Job Overview
Location
Anywhere in the U.S.
Job Type
Full-time
Category
HR & Recruiting
Date Posted
July 1, 2026
Full Job Description
đź“‹ Description
- • 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 long-term vision and day-to-day performance of the function.
- • This role involves developing and executing multi-year Risk Adjustment business plans, leading provider network engagement strategies, building and developing high-performing teams, maintaining regulatory and competitive intelligence, driving cross-functional governance, leveraging data and analytics for performance improvement, and overseeing audit readiness and compliance.
- • The VP partners closely with Clinical, Quality, Analytics, Finance, Provider Relations, and Member Experience teams to build a unified Risk Adjustment strategy that maximizes revenue accuracy, ensures CMS compliance, and demonstrates the true complexity of the members served.
- • The person in this role can achieve measurable improvement in RAF scores, HCC accuracy, and program performance while leading a dedicated team of managers, data analysts, and risk coders, with full people management authority and opportunity to drive financial integrity and long-term competitiveness in the Medicare Advantage market.
🎯 Requirements
- • 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 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
- • 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
- • 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
- • CPC (Certified Professional Coder) certification required
🏖️ Benefits
- • Opportunity to do work that really matters — changing and saving lives by serving seniors and the chronically ill and frail
- • Ample room for growth and innovation alongside the Alignment Health community in a fast-growing company
- • Ability to lead and develop a high-performing team while driving financial integrity and long-term competitiveness in the Medicare Advantage market
- • Competitive pay range of $227,952.00 - $341,928.00 based on experience, responsibilities, and qualifications
- • Equal Opportunity/Affirmative Action Employer commitment to diversity and inclusion
Skills & Technologies
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About Alignment Healthcare, LLC
Alignment Healthcare is a health insurance company that focuses on providing personalized care for seniors and underserved populations. They operate a value-based care model, aiming to improve health outcomes and reduce costs through integrated care teams, technology, and data analytics. Their services include Medicare Advantage plans, chronic care management, and home-based care. Alignment Healthcare partners with providers and aims to deliver a seamless and high-quality healthcare experience for its members, emphasizing proactive and preventive care to keep individuals healthy and out of the hospital.
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