Medicaid Risk Adjustment Lead Director

Responsibilities

• Reporting to the Executive Director of Revenue Integrity (RI), the Lead Director – Revenue Integrity (Medicaid) is responsible for driving segment-level performance across Medicaid risk adjustment and revenue integrity initiatives.
• Leads strategic program execution, performance management, and data-driven decision-making to ensure complete, accurate, and compliant revenue capture in a highly matrixed environment.
• Partners closely with enterprise, regional, and market stakeholders to identify performance risks, implement scalable solutions, and improve outcomes across Medicaid markets.
• Plays a critical role in advancing performance office governance, optimizing program effectiveness, and ensuring alignment with enterprise revenue integrity strategy.

• A minimum of 10 years of experience in Medicaid risk adjustment / revenue integrity
• Demonstrated expertise in Medicaid regulatory requirements, including risk adjustment methodologies and encounter data processes
• Proven ability to develop and execute strategic initiatives that deliver measurable business outcomes
• Strong leadership capabilities with advanced problem-solving and decision-making skills in complex, matrixed environments
• Experience leading large-scale, cross-functional programs with significant enterprise-wide impact
• Skilled at influencing senior stakeholders and driving change within highly regulated environments
• Consistent attendance and flexibility to travel as required.