Senior Director, Risk Adjustment (Project Management)

Title: Senior Director, Risk Adjustment
Reports to: Chief Business Officer
Classification: Director
Location: Boston (Hybrid)
Job description revision number and date: V 2.0; 4.18.2025

Organization Summary:
Community Care Cooperative (C3) is a 501(c)(3) non-profit multi-service organization governed by Federally Quality Health Centers (FQHCs). Our mission is to leverage the collective strengths of FQHCs to improve the health and wellness of the people we serve. We fulfill two primary business functions for the FQHCs we work with. First, we are an FQHC-led accountable care organization (ACO); second, we are a Management Services Organization (MSO) for FQHCs.

As an ACO, we negotiate value-based payor contracts on behalf of our FQHCs, hold and operate those contracts (including fulfilling many compliance, financial management, and population health management functions), and maximize the return to FQHCs of any incentive dollars earned. We are proud to have earned over $40M of incentive payments in our first four years and returned 98% of those earnings directly to our participating FQHCs. We are the largest Medicaid ACO in Massachusetts (>200,000 attributed lives), and we operate national Medicare ACO contracts across several states and the District of Columbia

As an MSO, we (along with our subsidiary companies, which are also FQHC-led non-profits) provide several financial, operational, and technological services to groups of FQHCs. These services include Epic EHR licensing and implementation; pharmacy operations consulting as well as the building and direct operation of on-site retail pharmacies; billing and credentialing; employer-sponsored insurance; and others.

We are a fast-growing, dynamic organization developing new partnerships and programs to improve the health of members and communities, and to strengthen our health center partners. We have won Best Places to Work recognition from the Boston Globe for the last three consecutive years.

Job Summary:
Reporting to the Chief Business Officer, the Senior Director, Risk Adjustment is responsible for the success of the companys risk adjustment performance across its Medicaid, Medicare, and other lines of business. The Senior Director will have a strong performance- and finance- orientation, and will be end-to-end accountable for developing, implementing, evaluating, and maintaining a risk adjustment strategy and supporting workstreams that drive maximum

financial value for the company and the FQHCs we work with, while complying with all relevant rules and regulations.

The Senior Director will initially oversee a team of approximately ten FTE of risk coders. The composition and size of this team may evolve to best support our developing risk adjustment strategy.

The Senior Director is an experienced risk adjustment professional who has led similar functions at other organizations, has up-to-date expertise on the latest Medicare risk adjustment models and best practices, and has worked with provider organizations doing change management. The Senior Director has a strong analytic and quantitative skillset and leads their work with a rigorous focus on maximizing its return on investment.

This position will be a key leader in the organization and will have significant exposure to the executive team and other members of senior leadership, as well as to FQHC leadership teams externally.

Responsibilities:
End-to-end accountable for C3s risk adjustment strategy, including:
o Assessing the organizations performance and developing data-informed goals and targets for improvement
o Identifying the areas of most significant impactable opportunity
o Developing workstreams that address this opportunity, including performance improvement efforts with FQHCs as well as centralized activities C3 can take to close risk gaps. These workstreams include (but are not limited to) opportunities to refine C3s Epic EHR asset to maximally support risk adjustment performance, and opportunities to bring in third-party AI and other technology to support achieving maximum impact with maximum efficiency
o Leading the implementation of these efforts
o Monitoring and evaluating these efforts, and adjusting the strategy as needed. Taking a strong performance- and finance-orientation, leads (and directly performs as needed) constant analytics efforts to understand our evolving risk adjustment performance, opportunities, and the success and ROI of our strategies
o Overseeing the successful achievement of C3s performance goals for risk
adjustment with maximum ROI
Oversees a team of Clinical Risk Coders (CRCs) and Clinical Documentation Improvement Specialists (CDIs), develops efficient and compliant workflows, and ensures ongoing team performance monitoring and quality assurance. The composition and size of the team may evolve as needed to support the risk adjustment strategy. Occasionally completes record review, coding, and auditing using electronic access to FQHC EHRs, to supplement the work of the risk coder team
Maintains expertise in ICD-10-CM coding guidelines, AHA Coding Clinic Guidance and MassHealth and Medicare Risk Adjustment methodologies
Maintains an open and collaborative working relationship with an internal team of health center-facing staff, IT, Analytics, as well as health center leadership and risk adjustment staff

Ensures exceptional compliance with all relevant rules and regulations for all coding and billing efforts, and leads the response to any audits of risk adjustment activities
Performs other duties that arise in the course of C3s risk adjustment work

Required Skills:
Significant subject matter expertise in risk adjustment, including Medicare. Additional experience with Medicaid risk adjustment preferred. The ideal candidate has led the risk adjustment function for another payor or ACO in Medicare and/or Medicaid
Exceptional financial and data analysis skills. Can build financial models to estimate ROI of ongoing risk adjustment interventions, can work fluently with C3s external actuaries and internal finance department, and can evaluate claims and chart data to advise ongoing risk adjustment strategy
Senior management experience. Has led medium-to-large teams, recruited and retained staff, and ideally done so during times of change
Strong interpersonal skills and experience with change management and practice transformation with healthcare providers
Excellent project management skills and attention to detail. Can take high-level direction and independently execute large and fast-moving projects
Ability to juggle multiple priorities in a fast-paced start-up environment
A strong commitment to the organizations mission
Proficiency in MS Office applications
Ability to lead with influence in a matrix environment. Ability to work collaboratively, across the organization, and as part of a team
Ability to communicate dexterously across a diverse range of stakeholders, from executive management (CEOs, CMOs, CFOs, COOs), to primary care and support staff responsible for driving the success of strategic programs on the ground

Desired Other Skills:
Expertise with multiple EHRs, particularly Epic
Familiarity with the MassHealth ACO program
Familiarity with Federally Qualified Health Centers
Experience with anti-racism activities, and/or lived experience with racism is highly preferred

Qualifications:
Masters level degree education or equivalent experience

** In compliance with Covid-19 Infection Control practices per Mass.gov recommendations, we require all employees to be vaccinated consistent with applicable law. **