Medical Director, Risk Adjustment Los Angeles, CA | Hybrid in Los Angeles

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Job DescriptionJob Description

Medical Director, Risk Adjustment Los Angeles, CA (Hybrid)

Compensation: $200,000 $280,000 per year + Bonus
Schedule: Full-Time | Hybrid (Onsite & Remote)

Overview:

Were seeking a Medical Director, Risk Adjustment to lead and advance our clinical risk adjustment strategy. This physician leader will play a key role in ensuring accurate documentation of patient complexity and chronic conditions while maintaining full compliance with CMS requirements and supporting overall revenue integrity.

This is an exceptional opportunity for a seasoned physician who thrives at the intersection of clinical excellence, data-driven decision-making, and value-based care.

Key Responsibilities:

Clinical Leadership

• Provide physician leadership in risk adjustment strategy and accurate capture of patient complexity.

• Collaborate with senior leadership to establish goals and monitor outcomes tied to risk adjustment and revenue integrity.

Provider Engagement & Education

• Develop and deliver education programs for physicians, APPs, and clinical staff focused on documentation integrity and coding accuracy.

• Act as a trusted advisor and subject matter expert on HCC coding and best practices.

• Champion prospective risk capture at the point of care.

Data & Performance Improvement

• Review documentation, coding, and quality data to identify opportunities for improvement at the provider and market levels.

• Lead targeted interventions to enhance RAF accuracy, reduce audit risk, and improve compliance.

• Partner with analytics teams to develop dashboards and performance tracking tools.

Cross-Functional Collaboration

• Work closely with coding, compliance, analytics, and operations teams to align risk adjustment with broader organizational goals.

• Support initiatives that advance quality, value-based care, and financial performance.

Compliance & Audit Readiness

• Ensure adherence to CMS and OIG regulations, including RADV requirements.

• Maintain audit-ready documentation and proactively adapt to regulatory changes to protect revenue integrity.

Qualifications:

• MD or DO with active, unrestricted medical license (required)

• Board Certification in Internal Medicine, Family Medicine, or related specialty ()

• 8+ years of clinical practice experience, with 35 years focused on risk adjustment, CDI, or value-based care

• Proven success leading provider education and engagement programs

• Strong understanding of Medicare Advantage and CMS risk adjustment methodology (HCC coding, RAF scoring, RADV audits)

Why Join Us:

• Competitive compensation and bonus structure

• Hybrid work flexibility (Los Angeles, CA area)

• Mission-driven organization focused on improving outcomes through value-based care

• Collaborative, innovative environment

For more information contact: Stephen.kanfer@optigygroup.com (954) 263-5115

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