Director, Risk Adjustment Health Plans Arizona

Primary City/State:

Arizona, Arizona

Department Name:

Risk Adjustment

Work Shift:

Day

Job Category:

General Operations

Great careers are built at Banner. We understand that talented professionals appreciate having options. We are proud to offer our team members many career and lifestyle choices including remote & hybrid work options. Apply today.

 

Recognized nationally as an innovative leader in health care, Banner Plans & Networks (BPN) integrates Medicare and private health plans to reduce healthcare costs while keeping our members in optimal health. Known for our innovative, collaborative, and team-oriented approach, BPN offers a variety of career opportunities and innovative employment options by offering remote and hybrid work settings.

 

As a Director, Risk Adjustment Health Plan, you will call upon your extensive experience in Medical Coding and Leadership daily. You will be responsible for accurate Hierarchical Condition Category Coding, HCC Coding, for perspective and concurrent processes. Experience in value based and full risk contacts from a medical group perspective is required for this role. Arizona residency is also required for this role.

Your work location will be remote hybrid requiring some meetings at Banner's Corporate Offices. Arizona residency is highly preferred for this position. Your work week will be Monday-Friday working in Arizona Business Hours. If this role sounds like the next step in your leadership journey, Apply today!

Your pay and benefits are important components of your journey at Banner Health. This opportunity includes the option to participate in a variety of health, financial, and security benefits. In addition, this position may be eligible for our Management Incentive Program as part of your Total Rewards package.

Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.

POSITION SUMMARY

The position is responsible for leading and managing all aspects of coding operations, including prospective and concurrent risk adjustment coding, for Banner Plans and Network. This role ensures compliance with regulatory guidelines, promotes high coding accuracy, and drives strategic initiatives to optimize risk adjustment performance. The ideal candidate is an experienced leader with a deep understanding of coding processes, risk adjustment strategies, and healthcare regulations.

CORE FUNCTIONS
1. Guides the development and implementation of short and long-range goals and objectives for the designated business entity’s coding and abstracting programs. Provides leadership and expertise in the development, implementation, oversight, and evaluation of coding/data abstraction programs for the system. Incorporates best practices and responds to emerging trends to enhance operations, programs, and/or services. Implements and evaluates strategic programs, develops effective tools to measure performance, analyzes related data, prepares reports, and makes recommendations to senior leadership based on findings.

2. Directs, supervises, and evaluates the work of staff and managers. Holds staff accountable for achieving plans and performance targets. Works with staff to identify and resolve the most complex issues and problems impacting health management coding operations. Supports development and continued professional growth to meet company and individual goals for long-term success. Demonstrates an expectation for continuous quality improvement utilizing processes that include consideration of all stakeholders.

3. Builds and supports effective relationships with internal and external stakeholders and organizations. Develops partnerships, coordinates activities, reviews work, exchanges information, and/or resolves problems related to coding and abstraction programs and/or services.

4. Directs and participates in the development, implementation, and consistent application of effective organizational policies, procedures, and practices. Develops and supports internal controls to ensure that assets are safeguarded, policies and operating procedures are followed, necessary controls are effective and efficient, and compliance with current laws and regulations is achieved.

5. Develops and oversees the department budget to meet corporate goals and objectives. Meets annual budgetary goals. Translates organizational plans, goals, and initiatives into assumptions for annual operating and/or capital budgets. Negotiates contracts with external vendors for products and/or services and monitors/evaluates quality and/or performance. Manages and reports expenditures.

6. Communicates the department vision, translating it into actionable projects and activities. Maximizes management staff’s contributions and assures timely decision-making reflecting the mission, vision, and values of the system.

7. Reviews, prepares, analyzes, and presents reports and recommendations to senior leadership regarding operations, programs, services, and/or other applicable areas of interest in order to provide concise and accurate information that aids in decision-making.

8. May lead or facilitate task forces, teams, and/or councils to plan, implement and coordinate coding related programs, services, and/or educational opportunities for the organization.

9. Position will lead the strategic development and execution of coding initiatives within a provider-sponsored health organization (PHSO), ensuring accurate risk capture across Medicare Advantage, ACA and Medicaid populations. This role is responsible for overseeing prospective and concurrent coding programs, integrating AI-driven and NLP-supported solutions into EHR workflows, and driving provider engagement to optimize risk adjustment documentation at the point of care. The incumbent will manage a team of coding professionals, collaborate with clinical leadership, and ensure compliance with CMS and state regulatory requirements while minimizing audit risk. Additionally, they will leverage data analytics and predictive modeling to enhance coding accuracy, support financial performance, and align risk adjustment strategies with organizational goals. This position has administrative leadership responsibility for the Risk Adjustment Coding strategic and daily operations across BPN. Position has wide latitude for independent decision making within the framework of delegated authority. Responsible for strategically planning all risk adjustment coding operations, consistent with Banner priorities, to reach short and long term goals. Leads, participates and/or establishes various system process improvement teams or work groups. This position requires the skill to negotiate and influence. The internal customers include senior leadership, medical directors, analytics, IT, care transformation, revenue cycle, compliance, and provider offices.

MINIMUM QUALIFICATIONS

Requires a bachelor's degree or equivalent combination of education and experience.

National coding certification from AAPC or AHIMA to include one or more of the following: Certified Professional Coder (CPC), Certified Coding Specialist-Physician (CCS P), Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), and/or one of the sub coding certifications with respect to HCC/RAF.

Expert-level working knowledge of principles, practices, and operations in assigned area of responsibility as normally obtained through the completion of a Bachelor’s Degree in a relevant field.  

Requires seven plus years of related experience, including a minimum of five years of progressively responsible managerial experience in designated facility, business entity or area, including a minimum of two years management level experience within a major health care organization, health system setting, or large multi-operational corporate environment in complex industries similar to healthcare or more than 5 years in a leadership role. 

Significant technical and managerial experience, typically gained through 7 to 10 years relevant experience.

The ideal candidate has extensive experience in risk adjustment coding operations, provider education, and technology-enabled coding solutions, with a strong background in managed care, value-based care, and regulatory compliance.

PREFERRED QUALIFICATIONS

Additional related education and/or experience preferred.

EEO Statement:

EEO/Female/Minority/Disability/Veterans

Our organization supports a drug-free work environment.

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