Director, Risk Adjustment Coding & Revenue Cycle Operations

Who We Are

At Suvida Healthcare, we are not just caregivers; we're compassionate advocates dedicated to enriching the lives of our cherished seniors. As a Team Member with us, you will embark on a fulfilling journey where your skills and empathy converge to make a meaningful impact on the well‑being of an underserved community and their families. Our multi‑disciplinary primary care program is built to address the physical, behavioral, social, and cultural needs of Medicare‑eligible Hispanic seniors.

Celebrate diversity and inclusivity in a workplace that attracts, engages, values, rewards, and recognizes the unique needs and backgrounds of both, our patients and our team. We believe that a rich tapestry of experiences, shared interests, and perspectives enhances the care we provide, making us a stronger, service‑centered, and more compassionate healthcare family and Employer of Choice! Will you join us Suvidanos, to help achieve our Higher Purpose?

We are an empowered primary care team, clinical operations, and support team creating health equity through an exceptional clinical and consumer experience that improves the quality of life for the people, families, and neighborhoods we serve. We tailor our primary care program to the culture, language, social, and overall well‑being of the seniors we serve.

Our Culture & Core Beliefs

Earn Trust
Building Relationships
Creating Joy
Doing Right
Improving Every Day
Moving Forward

Purpose Driven Career
Competitive Pay
Best-In-Class Medical/Dental Coverage
Free Mental Health & Life Coaching for Team Members and their Dependents
Holiday Time Off with Pay
Paid Community Service Day
Paid Parental/Family Leave
Paid Bereavement Leave
Generous Paid Time Off (PTO)
401k Retirement Plan with Company Match
And much more…

We are seeking an experienced Director of Medicare Risk Adjustment and Revenue Cycle Operations to lead our revenue cycle operations in a dynamic, growth‑stage environment. This critical leadership role will oversee all aspects of Medicare Advantage billing, coding accuracy, and risk adjustment processes under our full‑risk primary care model. The ideal candidate will bring deep expertise in value‑based care and a proven track record of building scalable systems that drive financial performance while ensuring regulatory compliance.

• Direct all Medicare Advantage billing operations, ensuring accurate and timely claim submission and resolution under global capitation arrangements
• Develop and implement comprehensive billing and coding strategies that optimize revenue capture while maintaining compliance with CMS regulations
• Work closely with operations and clinical operations to optimize processes and ensure efficient revenue cycle management
• Lead and manage the Medicare Risk Adjustment program, ensuring alignment with organizational goals and regulatory requirements
• Develop and implement strategies to improve accuracy in the capture of patient conditions
• Collaborate with clinical teams, operational leaders, and quality departments to identify opportunities for improvement and address challenges within the risk adjustment process
• Stay current with industry trends, CMS regulations, and best practices related to Medicare Risk Adjustment and coding
• Establish quality assurance programs to ensure diagnosis coding accurately reflects patient acuity and complexity
• Develop and monitor key performance indicators for risk adjustment accuracy, including risk adjustment factor (RAF) trends and HCC capture rates
• Maintain expert knowledge of Medicare Advantage regulations, CMS coding guidelines, and RADV audit requirements
• Design and oversee internal audit programs to proactively identify and remediate coding accuracy issues
• Ensure compliance with all federal and state regulations governing Medicare billing and risk adjustment
• Manage external audit responses and work with legal/compliance teams on regulatory inquiries
• Build, mentor, and scale a high‑performing team of billing and coding professionals to support company growth
• Establish training programs and competency standards for coding staff, including…