Director - Risk Adjustment & Medical Coding Operations (Hyderabad)

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: hr@novelitercm.com .