Director Risk Adjustment and Clinical Documentation Improvement-SWHR

Director of Risk Adjustment and Clinical Documentation Improvement -Southwestern Health Resources-Clinically Integrated Network (SWHR-CIN)

At Southwestern Health Resources (SWHR), we believe healthcare can be more integrated, accessible, and affordable for all.

Our purpose is simple yet powerful: to build a better way to care, together.

SWHR is a patient-centered, clinically integrated network that brings together academic and community clinicians, researchers, hospitals, and ambulatory facilities.

We partner with physicians to drive a new model of value-based, high-quality, data-driven healthcare-serving everyone in the communities we touch.

By combining the strengths of UT Southwestern Medical Center and Texas Health Resources, we've built the largest provider network in North Texas, giving our team members the opportunity to make a meaningful impact at scale.

Healthcare in the U.S.

is evolving rapidly, and SWHR is committed to leading that change-moving healthcare forward, together.

Position Summary

The Director of Risk Adjustment and Clinical Documentation Improvement provides enterprise leadership for risk adjustment strategy, clinical documentation integrity, and coding accuracy across Medicare Advantage, Medicare, Medicaid, Commercial, and ACA lines of business.

This role drives accurate risk score capture, regulatory compliance, provider engagement, and financial performance through scalable programs, analytics, and cross-functional collaboration.

· · Work location: Hybrid-Expectation is onsite Tuesday thru Thursday in Farmers Branch, TX .

Position Duties

Own and execute the enterprise risk adjustment and CDI strategy across all payer lines of business.

Drive accurate and compliant HCC capture to optimize RAF performance and revenue outcomes.

Establish governance structures for risk adjustment programs, audits, and performance reporting.

Develop and oversee prospective, concurrent, and retrospective CDI and coding review strategies.

Lead internal and external audit response, validation activities, and corrective action planning.

Partner with analytics and IT teams to develop predictive models, dashboards, and provider-level insights.

Ensure compliance with CMS, HHS, OIG, and payer-specific risk adjustment requirements.

Develop and scale provider education programs focused on documentation accuracy and risk capture.

Oversee onboarding, training, and performance management of physicians, APPs, and coding staff.

Accountable for vendor relationships, performance, contracts, and ROI related to risk adjustment initiatives.

Identify emerging regulatory and audit risks and proactively implement mitigation strategies.

Develop departmental budgets, workforce plans, KPIs, and long-term operating roadmaps.

Lead, mentor, and retain high-performing clinical, coding, and analytics teams.

Present performance results, risk exposure, and strategic recommendations to executive leadership.

Other duties as assigned.

Education
Bachel...