Head of Risk Adjustment (New York)

Company and Role Description

Antidote Healths mission is to redefine healthcare by providing affordable, high-quality, and accessible care and insurance products. As the Head of Risk Adjustment, you will lead our risk adjustment strategy, operations, and analytics to ensure compliance, accuracy, and financial sustainability. You will collaborate with cross-functional partners in Clinical, Provider Network, Product, Finance, Compliance, and Data Science to design and execute a best-in-class program that ensures complete and accurate risk capture, supports value-based care, and enables equitable outcomes for our members.

Key Responsibilities

Strategic Leadership & Program Management

• Define and execute Antidotes risk adjustment strategy on the ACA Marketplace.
• Lead and manage the Risk Adjustment process with finance, product, clinical, marketing, and operations, fostering a culture of accountability, innovation, collaboration, and continuous improvement.
• Develop and oversee programs to maximize risk score accuracy, including chart reviews, suspecting, and gap closure initiatives.

Risk Adjustment Operations & Analytics

Compliance & Quality Assurance

Cross-Functional Collaboration

Qualifications & Skills

Required :

Preferred :