Job Title: Associate Vice President (AVP) Risk Adjustment & Medical Coding Operations (HCC)

Location: Hyderabad

Industry: US Healthcare | Medical Coding | Risk Adjustment

Job Summary

Results-oriented healthcare operations leader with extensive experience in Risk Adjustment, HCC Coding, ICD-10-CM, and value-based care operations. Proven expertise in leading large-scale medical coding teams, driving operational excellence, ensuring CMS compliance, improving coding accuracy, and delivering high-quality services to U.S. healthcare clients. Skilled in strategic planning, client relationship management, financial oversight, and process improvement.

Key Responsibilities:

- Lead end-to-end Risk Adjustment and HCC Coding operations for Medicare Advantage and other value-based care programs.
- Manage large teams of coding managers, quality analysts, auditors, and certified medical coders.
- Drive operational KPIs including productivity, quality, turnaround time (TAT), SLA adherence, and client satisfaction.
- Ensure compliance with CMS, ICD-10-CM, HCC, RADV, and other regulatory guidelines.
- Develop and implement coding quality improvement initiatives through audits, education, and feedback.
- Collaborate with clients, physicians, and cross-functional teams to improve documentation accuracy and risk score capture.
- Oversee workforce planning, budgeting, resource allocation, and financial performance.
- Present business reviews, operational dashboards, and strategic updates to executive leadership and clients.
- Lead process automation, digital transformation, and continuous improvement initiatives.
- Mentor and develop leadership teams while fostering a culture of accountability and operational excellence.

Required Skills:





- Risk Adjustment
- HCC Coding
- Medical Coding
- ICD-10-CM
- Medicare Advantage
- CMS Risk Adjustment
- Healthcare Operations
- Revenue Cycle Management (RCM)
- Coding Quality & Compliance
- Medical Coding Audits
- Team Management
- Client Management
- Process Improvement
- Workforce Planning
- Leadership
- Strategic Planning
- Healthcare Analytics

Experience & Qualifications:

- 15+ years of progressive experience in U.S. Healthcare, with deep expertise in HCC Risk Adjustment, ICD-10-CM coding, and Medicare Advantage programs.
- Proven experience in an AVP, Senior Director, Delivery Head, or equivalent leadership role, managing enterprise-scale Risk Adjustment operations.
- Demonstrated success in leading large HCC coding operations (300+ FTEs preferred), including Operations, Quality, Audits, Training, and Client Delivery.
- Strong expertise in HCC Risk Adjustment, CMS-HCC models, ICD-10-CM coding guidelines, Medicare Advantage, RADV audits, Clinical Documentation Improvement (CDI), and CMS compliance.
- Thorough understanding of Evaluation & Management (E&M;) documentation, provider education, coding quality, productivity management, and risk score optimization.
- Experience in managing client relationships, operational governance, SLA/KPI delivery, workforce planning, budgeting, and business growth initiatives.
- Certified coding credential such as CRC, CPC, CCS, CIC, or equivalent from AAPC or AHIMA is preferred.
- Robust leadership, stakeholder management, client-facing, communication, analytical, and decision-making skills with a proven track record of driving operational excellence and continuous improvement.

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

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