AVP Risk Adjustment & Medical Coding Operations (Hyderabad)

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: .