Alpine Physician Partners
Vice President, Risk Adjustment
Alpine Physician Partners, Granite Heights, Wisconsin, United States
Vice President, Risk Adjustment – Alpine Physician Partners
Lead and oversee Alpine’s Medicare Advantage Risk Adjustment strategy and operations across all markets. Ensure accurate, compliant and complete capture of patient risk while reducing workflow variation and elevating documentation quality.
Essential Duties Enterprise Strategy & Leadership
Develop and execute end-to-end risk adjustment strategy and multi-year roadmap, aligning coding accuracy, documentation quality, analytics enablement and clinician workflows to drive compliant RAF performance.
Set annual RAF program KPIs with market and clinic level glidepaths to goal; establish management processes for monitoring, reporting and driving corrective actions across markets.
Lead enterprise-level governance and serve as Alpine’s subject matter expert on Risk Adjustment, ensuring alignment across Operations, Clinical, Analytics and Finance.
Program Operations
Oversee all prospective, concurrent, and retrospective RAF workflows including robust quality assurance processes to ensure optimized throughput and quality.
Partner with Clinical and Operations leaders to integrate risk adjustment into clinic workflows and processes.
Develop and deliver provider education, coaching, and feedback mechanisms to improve documentation accuracy and reduce burden.
Establish dashboards and KPIs to monitor coding accuracy, completeness, provider engagement and operational performance.
Cross-Functional & External Partnerships
Partner with Analytics to leverage opportunity models and predictive insights to guide closed-loop coding and documentation workflows.
Evaluate and optimize technology platforms (e.g., NLP tools, coding engines) to improve accuracy, efficiency and workflow integration.
Partner with Finance to forecast RAF revenue and evaluate initiative impact.
Collaborate with operations to operationalize RAF workflows, performance expectations and variation reduction.
Regulatory & Compliance
Ensure compliance with CMS, HPMS, NCQA and state regulations.
Lead RADV and other CMS audit activities, ensuring organizational preparedness, submission quality and corrective action.
Maintain strong internal QA processes to safeguard program integrity and prevent errors.
Education
Bachelor’s degree required; Master’s degree preferred (MPH, MHA, MBA or related).
Experience
10 years of experience in Medicare Advantage Risk Adjustment within a provider organization, health plan or risk-bearing entity.
Demonstrated success in improving RAF performance and documentation quality at scaled organizations.
Strong leadership experience with ability to influence senior executives, clinicians, operations leaders and external partners.
Deep understanding of CMS risk adjustment rules, RADV audits, ICD-10 coding standards, V28 transition impacts (if applicable) and documentation requirements.
Experience managing multi-site operations, vendors, budgets and cross-functional initiatives.
High level of analytical competency with understanding of VBC economics, financial modeling and operational performance metrics.
Excellent communication, change management and clinician engagement skills.
Knowledge, Skills, Abilities
Structured & Systems Thinking – Connects coding, clinical practice, analytics and financial outcomes into a unified enterprise strategy.
Cross-Functional Influence – Builds alignment across diverse stakeholder groups.
Operational Excellence – Drives measurable improvements through disciplined processes and accountability.
Change Management Leadership – Leads providers and teams through behavior change with clarity and empathy.
Technical Fluency – Understands risk coding platforms, data systems, analytics tools and EMRs.
Regulatory Rigor – Maintains a high-integrity, compliant, audit-ready program at all times.
Work Environment Travel up to 25% is required. We believe in a culture of transformation and growth, encouraging over-achievers who bring passion to senior care delivery.
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Essential Duties Enterprise Strategy & Leadership
Develop and execute end-to-end risk adjustment strategy and multi-year roadmap, aligning coding accuracy, documentation quality, analytics enablement and clinician workflows to drive compliant RAF performance.
Set annual RAF program KPIs with market and clinic level glidepaths to goal; establish management processes for monitoring, reporting and driving corrective actions across markets.
Lead enterprise-level governance and serve as Alpine’s subject matter expert on Risk Adjustment, ensuring alignment across Operations, Clinical, Analytics and Finance.
Program Operations
Oversee all prospective, concurrent, and retrospective RAF workflows including robust quality assurance processes to ensure optimized throughput and quality.
Partner with Clinical and Operations leaders to integrate risk adjustment into clinic workflows and processes.
Develop and deliver provider education, coaching, and feedback mechanisms to improve documentation accuracy and reduce burden.
Establish dashboards and KPIs to monitor coding accuracy, completeness, provider engagement and operational performance.
Cross-Functional & External Partnerships
Partner with Analytics to leverage opportunity models and predictive insights to guide closed-loop coding and documentation workflows.
Evaluate and optimize technology platforms (e.g., NLP tools, coding engines) to improve accuracy, efficiency and workflow integration.
Partner with Finance to forecast RAF revenue and evaluate initiative impact.
Collaborate with operations to operationalize RAF workflows, performance expectations and variation reduction.
Regulatory & Compliance
Ensure compliance with CMS, HPMS, NCQA and state regulations.
Lead RADV and other CMS audit activities, ensuring organizational preparedness, submission quality and corrective action.
Maintain strong internal QA processes to safeguard program integrity and prevent errors.
Education
Bachelor’s degree required; Master’s degree preferred (MPH, MHA, MBA or related).
Experience
10 years of experience in Medicare Advantage Risk Adjustment within a provider organization, health plan or risk-bearing entity.
Demonstrated success in improving RAF performance and documentation quality at scaled organizations.
Strong leadership experience with ability to influence senior executives, clinicians, operations leaders and external partners.
Deep understanding of CMS risk adjustment rules, RADV audits, ICD-10 coding standards, V28 transition impacts (if applicable) and documentation requirements.
Experience managing multi-site operations, vendors, budgets and cross-functional initiatives.
High level of analytical competency with understanding of VBC economics, financial modeling and operational performance metrics.
Excellent communication, change management and clinician engagement skills.
Knowledge, Skills, Abilities
Structured & Systems Thinking – Connects coding, clinical practice, analytics and financial outcomes into a unified enterprise strategy.
Cross-Functional Influence – Builds alignment across diverse stakeholder groups.
Operational Excellence – Drives measurable improvements through disciplined processes and accountability.
Change Management Leadership – Leads providers and teams through behavior change with clarity and empathy.
Technical Fluency – Understands risk coding platforms, data systems, analytics tools and EMRs.
Regulatory Rigor – Maintains a high-integrity, compliant, audit-ready program at all times.
Work Environment Travel up to 25% is required. We believe in a culture of transformation and growth, encouraging over-achievers who bring passion to senior care delivery.
#J-18808-Ljbffr