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 effectively planned, executed and aligned with organizational goals. Responsibilities include tracking the risk adjustment project portfolio, coordinating timelines across departments and ensuring seamless communication between leadership, operational teams and external vendors. Identify and address roadblocks, ensuring that risk adjustment programs remain on track and deliver measurable outcomes.

7. Responsible for development of high-impact executive presentations and executive summaries to keep leadership and stakeholders informed on risk adjustment progress and key initiatives. Translate complex data and program insights into clear, actionable updates, ensuring that decision-makers have the necessary information to drive strategy. Facilitate the management process, track follow-ups and ensure that priorities are consistently communicated and executed across teams.

8. Ensures that risk adjustment activities adhere to CMS, HHS and Medicaid regulations, staying ahead of policy changes that impact coding, data submissions and vendor processes. Works closely with compliance, legal, and internal quality assurance, to monitor evolving regulatory requirements, integrating best practices to mitigate risk and maintain audit readiness. Oversee vendor compliance, ensuring contractual obligations align with industry standards and regulatory expectations.

9. Strong collaboration with internal and external stakeholders, including health plans, provider networks, vendors and senior leadership, to align risk adjustment strategies with organizational goals. Develop engagement strategies to improve provider participation, ensuring that risk adjustment initiatives are well-integrated into clinical and administrative workflows.

MINIMUM QUALIFICATIONS

Expert-level working knowledge of principles, practices, and operations in assigned area of responsibility as normally obtained through the completion of a Bachelor’s Degree in a relevant field.

Significant technical and managerial experience, typically gained through seven plus years of relevant experience, including progressively responsible managerial experience in designated facility, business entity or area, also including a minimum of two years management level experience within a major health care organization, health system setting, or large multi-operational corporate environment in complex industries similar to healthcare or more than 5 years in a leadership role.

The ideal candidate has extensive experience in risk adjustment coding operations, provider education, and technology-enabled coding solutions, with a strong background in managed care, value-based care, and regulatory compliance.

PREFERRED QUALIFICATIONS

Master’s degree preferred. Knowledge of regulatory requirements from CMS, HHS, and state agencies, including RADV audits and risk adjustment data validation. Familiarity with HER systems, claims processing and provider engagement strategies related to risk adjustment.

Additional related education and/or experience preferred.

EEO Statement:

EEO/Female/Minority/Disability/Veterans

Our organization supports a drug-free work environment.

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