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?

What Makes Us Unique

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. 

How We Work

Our Culture & Core Beliefs

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

Our Promise

• 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....

What You’ll Do 

Position Summary

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.

Responsibilities

Revenue Cycle Leadership

·      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

Risk Adjustment and HCC Coding

·      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 codi