Director, Risk Adjustment Arizona Residency Required

Department Name:

Risk Adjustment

Work Shift:

Day

Job Category:

General Operations

Estimated Pay Range:

$53.63 - $89.38 / hour, based on location, education, & experience.

In accordance with State Pay Transparency Rules.

Banner Health was recently recognized on Forbes inaugural list of America’s Dream Employers 2025. This list highlights employers across the country that prioritize workplace excellence and the happiness, satisfaction, wellbeing and fulfilment of their employees.

Banner Plans & Networks (BPN) is a nationally recognized healthcare leader that integrates Medicare and private health plans. Our main goal is to reduce healthcare costs while keeping our members in optimal health. BPN is known for its innovative, collaborative, and team-oriented approach to healthcare. We offer diverse career opportunities, from entry-level to leadership positions, and extend our innovation to employment settings by including remote and hybrid opportunities.

As the Director of Risk Adjustment, you will lead a dynamic team focused on driving collaboration across analytics, IT systems, and operational processes. Your leadership will ensure seamless coordination between internal departments, external vendors, and provider-facing staff. You’ll also work closely with other Risk Adjustment teams within the department to align strategies and optimize performance.

This is a primarily remote position based in the Arizona time zone, with a standard Monday–Friday schedule. Occasional in-person meetings will be held at our Banner Corporate Centers.

If you're ready to make a meaningful impact and lead with purpose, we encourage you to 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

This position leads vendor management, oversees complex data transfers, and coordinates cross-functional initiatives that support our risk adjustment strategy. This position requires a strong understanding of analytics, IT systems, and operational processes to ensure effective collaboration between internal teams, vendors, and provider-facing staff. The incumbent will also be responsible for project oversight, executive reporting, and strategic communication to ensure alignment and progress across risk adjustment initiatives.

CORE FUNCTIONS
1. Ensures all risk adjustment vendors meet contractual obligations, performance benchmarks, and regulatory requirements. Assess vendor effectiveness, track key performance indicators and address any service gaps or compliance issues. Lead vendor governance meetings, negotiate improvements and drive accountability to optimize program success.

2. Assess risk adjustment vendor landscape to identify new opportunities, emerging technologies, and strategic partnerships that can enhance program performance. Research and evaluate potential vendors, comparing capabilities, costs and efficiencies to ensure Banner Health stays ahead of industry trends.

3. Coordinate with vendors, internal IT and analytics to manage complex data transfers, file exchanges and system integrations essential for risk adjustment programs. Oversee data accuracy, ensure timely submission of risk adjustment files and troubleshoot issues that impact performance.

4. Monitors key risk adjustment operations, coordinating across teams to troubleshoot problems, escalate challenges and develop action plans to address operational roadblocks.
 

5. Lead the risk adjustment program implementation, ensuring operational teams have the tools, training and resources needed for success. Work closely with provider-facing staff to integrate risk adjustment processes into clinical and administrative settings. Drive continuous process improvement by identifying inefficiencies, implementing best practices and leveraging data0driven insights to enhance program performance.

6. Strategic coordination and program oversight of risk adjustment, ensuring initiatives are eff