Director, Quality & Risk Adjustment Operations

Summary

Join Herself Health as the Director, Quality & Risk Adjustment Operations, leading the strategy and execution of HEDIS Quality and Burden of Illness programs. Partner with the Chief Clinical Officer to ensure accurate risk adjustment coding and effective strategies to address quality of care gaps. Collaborate with payer strategy and clinical operations teams to meet value-based care contract targets. This fast-paced role requires strategic thinking, data analysis, and strong leadership skills. The position is remote, with a strong preference for Minnesota-based candidates. You will manage a team, serve as a subject matter expert on HEDIS and risk adjustment, and manage key vendor partnerships.

Requirements

• Authorized to work in the United States
• Bachelor’s Degree required; Master’s Degree highly preferred
• Expert knowledge of CMS’ HEDIS Quality program and measures
• Expert knowledge of CMS regulatory rules and coding guidelines for Medicare Advantage risk adjustment coding
• Ability to dig deep into data to understand trends and drivers of performance
• Ability to effectively lead through influence and change
• Strong communications and presentation skills
• Experience working cross-functionally with providers, care teams, operations, and finance
• 3+ years of HEDIS Quality and Risk Adjustment experience
• 5+ years of experience leading teams
• Ability to travel up to 25% to MN clinics

Responsibilities

• Program performance management : own the strategic vision, develop and execute the strategic plan, and manage the day-to-day performance of the Quality and BOI programs to drive high quality outcomes for our patients and deliver on our contractual performance targets
• Team leadership : provide strategic direction, inspiration, coaching, and enablement for the VBC leaders, who oversee teams of Care Coordinators and Provider Educators, responsible for the day-to-day performance of our VBC operations; lead through influence in driving adoption of best practices by providers and clinical teams across the practice
• Practice subject matter expert: serve as the subject matter expert on HEDIS and risk adjustment through prior experience and staying informed on CMS technical and programmatic changes and communications
• Vendor management : own the strategic partnerships with key vendors that support our quality and BOI programs; ensure compliance and alignment to contractual obligations and drive improvement efforts with the vendor, as needed

Preferred Qualifications

• Certified Coding Specialist is nice to have, but not required
• Experience working in Electronic Medical Record (EMR) systems; experience with Athena is desirable