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
Bachelor's Degree Healthcare Administration, Health Information Management, or related field required
Master's Degree Healthcare Administration, Health Information Management, or related field preferred
Experience
8 years progressive risk adjustment and Medicare revenue management experience to include people management required
Licenses and Certifications
CPC - Certified Professional Coder CPC or CRC certification from AHIMA and/or AAPC required upon hire
Skills
People Management - Provides oversight and direction of department leaders in the areas of staffing, talent development, performance management, and resource planning to support strategic goals.
Strategy Execution - Translates organizational strategy into actionable department plans, aligning goals and operations to support long-term success and cross-functional coordination; ensures vision and strategy is clearly communicated to all staff.
Performance & Accountability - Owns department performance by setting clear expectations aligned to strategy, using data to measure and monitor results, identifying risks, generating solutions to improve outcomes and making decisions within departmental scope and escalating when appropriate.
Change Leadership & Operational Readiness - Design change initiatives by implementing new technologies and processes, lead teams through transition, ensuring resources are aligned for success and proactively communicating the purpose and benefit to build engagement.
Strategic Relationship Management - Builds and maintains strategic relationships across departments, with senior leadership, and with external partners, ensuring clear communication, alignment, situational transparency related to business priorities or emerging issues, and accountability for performance expectations.
Financial Resources & Stewardship - Oversees departmental budget and resource planning, ensuring effective use of funds, identifying opportunities for operational efficiency and continuous improvement and making informed decisions to balance competing initiatives and optimize department outcomes.
Why Southwestern Health Resources
As a Southwestern Health Resources you’ll enjoy: comprehensive benefits, including a 401(k) with match; paid time off; competitive health insurance choices; healthcare and dependent care spending account options; wellness programs to keep you and your family healthy; tuition reimbursement; a student loan repayment program; and more.
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