Job Title: Director - Risk Adjustment & Medical Coding Operations (HCC)

Location: Hyderabad

Industry: US Healthcare | Medical Coding | Risk Adjustment

Job Summary

We are seeking an experienced and agile Director Risk Adjustment & Medical Coding Operations (HCC) to lead end-to-end HCC coding operations for U.S. healthcare clients. The role is responsible for driving operational excellence, ensuring CMS compliance, managing client relationships, leading high-performing teams, and delivering quality outcomes aligned with organizational goals.

Key Responsibilities:

- Lead and oversee end-to-end HCC Risk Adjustment operations for Medicare Advantage and value-based care programs.
- Manage Coding Managers, Quality Auditors, Trainers, Team Leads, and Certified HCC Coders to achieve operational excellence.
- Drive productivity, quality, coding accuracy, turnaround time (TAT), SLA adherence, and client satisfaction.
- Ensure compliance with CMS-HCC, ICD-10-CM coding guidelines, Medicare Advantage regulations, and RADV audit requirements.
- Develop strategies to improve coding accuracy, documentation quality, risk score capture, and operational efficiency.
- Collaborate with clients, providers, and internal stakeholders to support quality and compliance initiatives.
- Lead workforce planning, capacity management, budgeting, resource allocation, and performance governance.
- Present business reviews, operational metrics, and improvement plans to senior leadership and clients.
- Drive continuous improvement,



automation, and process optimization initiatives.
- Mentor and develop leadership teams while fostering a culture of accountability and high performance.

Experience & Qualifications:

- 12+ years of experience in U.S. Healthcare, with significant expertise in Risk Adjustment (HCC) and Medical Coding Operations.
- 3+ years of experience in a leadership role such as Director, Associate Director, Senior Manager, or equivalent, managing HCC coding operations.
- Experience managing large coding teams (150300+ FTEs preferred).
- Strong knowledge of CMS-HCC, ICD-10-CM coding guidelines, Medicare Advantage, RADV, Clinical Documentation Improvement (CDI), and value-based care programs.
- Proven experience in client management, operational governance, workforce planning, quality management, and process improvement.
- CRC, CPC, CCS, CIC, or equivalent AAPC/AHIMA certification is preferred.
- Excellent leadership, communication, stakeholder management, analytical, and client-facing skills.

Preferred Skills:

- HCC Risk Adjustment
- CMS-HCC & Medicare Advantage
- ICD-10-CM Coding
- RADV Audits
- Clinical Documentation Improvement (CDI)
- Quality & Compliance
- Operations Management
- Client Relationship Management
- People Leadership
- Process Improvement & Operational Excellence
- Performance Management
- Budgeting & Resource Planning

Interested candidates can share their updated resume to: [email protected]

📌 Director - Risk Adjustment & Medical Coding Operations (Hyderabad)
🏢 Novelite Rcm
📍 Hyderabad