Mosaic Health
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Medical Director - Risk Adjustment
role at
Mosaic Health
Job Description Summary The Medical Director, Risk Adjustment - will serve as the clinical expert responsible for advancing CareMore Health’s risk adjustment strategy. This physician expert will guide providers in accurate and complete documentation of patient complexity and chronic conditions, ensuring compliance with CMS requirements while supporting enterprise revenue integrity. The role will focus on healthcare provider education, data-driven interventions, and cross-functional collaboration with coding, analytics, and operations teams to maximize risk score accuracy, reduce audit exposure, and align risk adjustment with clinical and business objectives.
Key Responsibilities Clinical Risk Adjustment Leadership
Provide physician leadership in CareMore’s risk adjustment strategy, ensuring accurate capture of patient complexity and chronic conditions.
Partner with enterprise leaders to set goals and monitor performance outcomes tied to risk adjustment and revenue integrity.
Provider Engagement & Education
Design, develop, and deliver education programs for physicians, advanced practice providers, and clinical staff to improve documentation integrity and coding accuracy.
Serve as a visible champion for prospective risk capture at the point of care.
Act as a trusted advisor and subject matter expert for providers on HCC coding and documentation best practices.
Data Analysis & Performance Improvement
Review coding, documentation, and quality data to identify performance gaps at provider, clinic, and market levels.
Lead targeted interventions to improve RAF accuracy, reduce audit risk, and strengthen compliance.
Collaborate with analytics teams to develop dashboards and reporting tools that track progress.
Cross-Functional Collaboration
Partner closely with coding, compliance, analytics, and operations teams to integrate risk adjustment into broader CareMore and Mosaic Health initiatives.
Ensure risk adjustment strategies support enterprise priorities in quality, value-based care, and financial performance.
Compliance & Audit Readiness
Ensure all risk adjustment practices adhere to CMS and OIG regulations, including RADV requirements.
Maintain audit-ready documentation and support compliance teams in responding to regulatory inquiries.
Proactively adapt strategies based on regulatory changes to protect revenue integrity and enterprise reputation.
Qualifications Education & Licensure
MD or DO required, with active, unrestricted medical license.
Board certification in Internal Medicine, Family Medicine, or related specialty strongly preferred.
Experience
8+ years of clinical practice experience, with at least 3–5 years in an expert-level role involving risk adjustment, clinical documentation improvement (CDI), or value-based care.
Demonstrated success leading provider education and engagement programs to improve coding and documentation.
Experience with Medicare Advantage and CMS risk adjustment methodology (HCC coding, RAF scoring, RADV audits).
Knowledge & Skills
Strong clinical and regulatory expertise in risk adjustment models and documentation standards.
Data-driven leader with proven ability to interpret coding and quality data and translate into actionable interventions.
Excellent communication and presentation skills, with ability to engage diverse provider audiences.
Effective collaborator and change agent, able to partner across clinical, operational, and business teams.
Reporting & Structure
Reports to: Vice President, Risk Adjustment & Quality (CareMore Health)
Location: Central to CareMore market and enterprise sites. (Southern California, Clark and Pima counties, AZ); requires 75% travel to market and enterprise sites.
Compensation: $192,153.42 - $240,191.77 annual salary & bonus eligible
Seniority level
Director
Employment type
Full-time
Job function
Health Care Provider
Industries
Hospitals and Health Care
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Medical Director - Risk Adjustment
role at
Mosaic Health
Job Description Summary The Medical Director, Risk Adjustment - will serve as the clinical expert responsible for advancing CareMore Health’s risk adjustment strategy. This physician expert will guide providers in accurate and complete documentation of patient complexity and chronic conditions, ensuring compliance with CMS requirements while supporting enterprise revenue integrity. The role will focus on healthcare provider education, data-driven interventions, and cross-functional collaboration with coding, analytics, and operations teams to maximize risk score accuracy, reduce audit exposure, and align risk adjustment with clinical and business objectives.
Key Responsibilities Clinical Risk Adjustment Leadership
Provide physician leadership in CareMore’s risk adjustment strategy, ensuring accurate capture of patient complexity and chronic conditions.
Partner with enterprise leaders to set goals and monitor performance outcomes tied to risk adjustment and revenue integrity.
Provider Engagement & Education
Design, develop, and deliver education programs for physicians, advanced practice providers, and clinical staff to improve documentation integrity and coding accuracy.
Serve as a visible champion for prospective risk capture at the point of care.
Act as a trusted advisor and subject matter expert for providers on HCC coding and documentation best practices.
Data Analysis & Performance Improvement
Review coding, documentation, and quality data to identify performance gaps at provider, clinic, and market levels.
Lead targeted interventions to improve RAF accuracy, reduce audit risk, and strengthen compliance.
Collaborate with analytics teams to develop dashboards and reporting tools that track progress.
Cross-Functional Collaboration
Partner closely with coding, compliance, analytics, and operations teams to integrate risk adjustment into broader CareMore and Mosaic Health initiatives.
Ensure risk adjustment strategies support enterprise priorities in quality, value-based care, and financial performance.
Compliance & Audit Readiness
Ensure all risk adjustment practices adhere to CMS and OIG regulations, including RADV requirements.
Maintain audit-ready documentation and support compliance teams in responding to regulatory inquiries.
Proactively adapt strategies based on regulatory changes to protect revenue integrity and enterprise reputation.
Qualifications Education & Licensure
MD or DO required, with active, unrestricted medical license.
Board certification in Internal Medicine, Family Medicine, or related specialty strongly preferred.
Experience
8+ years of clinical practice experience, with at least 3–5 years in an expert-level role involving risk adjustment, clinical documentation improvement (CDI), or value-based care.
Demonstrated success leading provider education and engagement programs to improve coding and documentation.
Experience with Medicare Advantage and CMS risk adjustment methodology (HCC coding, RAF scoring, RADV audits).
Knowledge & Skills
Strong clinical and regulatory expertise in risk adjustment models and documentation standards.
Data-driven leader with proven ability to interpret coding and quality data and translate into actionable interventions.
Excellent communication and presentation skills, with ability to engage diverse provider audiences.
Effective collaborator and change agent, able to partner across clinical, operational, and business teams.
Reporting & Structure
Reports to: Vice President, Risk Adjustment & Quality (CareMore Health)
Location: Central to CareMore market and enterprise sites. (Southern California, Clark and Pima counties, AZ); requires 75% travel to market and enterprise sites.
Compensation: $192,153.42 - $240,191.77 annual salary & bonus eligible
Seniority level
Director
Employment type
Full-time
Job function
Health Care Provider
Industries
Hospitals and Health Care
#J-18808-Ljbffr