Director, Clinical Excellence/BOI

Job Description Summary

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The Director develops and leads strategies to ensure the accurate and complete representation of patient disease burden through compliant clinical documentation and risk adjustment practices. This role uses data and performance trends to identify opportunities, establish organizational and practice-level priorities, and develop programs that improve documentation, coding accuracy, condition recapture, prevalence, and overall value-based care outcomes.

The Director leads a team and is responsible for translating BOI strategy into actionable initiatives within physician practices. The Director collaborates closely with providers and leadership across Risk Adjustment, Population Health,
Practice Operations, Quality, Finance, Analytics, Clinical Operations, and RBE partnerships to ensure BOI initiatives are coordinated, compliant, measurable, and successfully implemented.

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How will you make an impact & Requirements

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Essential Duties and Responsibilities

• Provide leadership and subject matter expertise for organizational Burden of Illness initiatives.
• Maintain knowledge of CMS-HCC methodologies, regulatory requirements, coding guidelines, and changes affecting BOI performance.
• Monitor key BOI indicators.
• Identify patterns in documentation and coding performance requiring provider or practice intervention.
• Ensure provider education strategies address identified documentation and coding opportunities.
• Establish BOI priorities for physician practices based on performance data and identified opportunities.
• Develop the framework teams use to execute BOI initiatives within practices.
• Segment and prioritize practices and providers based on level of support required.
• Monitor practice and provider progress against established BOI goals.
• Identify systemic barriers affecting practice execution and coordinate solutions across the organization.
• Develop scalable workflows that integrate BOI activities into routine practice operations.
• Ensure practice-facing BOI activities are coordinated to minimize disruption and improve provider engagement.
• Establish BOI strategies for practices participating in Risk Bearing Entity arrangements.
• Partner with RBE Partnership leadership to understand contractual priorities, performance opportunities, and partner expectations related to BOI.
• Monitor BOI performance across RBE populations and identify opportunities requiring intervention.
• Develop targeted improvement strategies for RBE practices based on identified performance gaps.
• Participate in RBE performance discussions when BOI expertise or leadership is required.
• Ensure BOI initiatives supporting RBE arrangements are appropriately prioritized, tracked, and executed.

Education and Experience

• Bachelor's degree in Healthcare Administration, Business Administration, Health Information Management, Public Health, preferred; equivalent combination of education and relevant professional experience may be considered.
• Active CRC or CPC certification strongly preferred.
• Minimum of 7 years of progressive experience in Medicare Risk Adjustment, Burden of Illness, healthcare analytics, population health, or related healthcare operations.
• Minimum of 3–5 years of leadership experience.
• Strong experience with CMS-HCC Risk Adjustment methodologies and reporting requirements.
• Experience working with physician practices and provider leadership.
• Experience with Medicare Advantage and value-based care arrangements required; ACO and risk-bearing arrangements preferred.
• Demonstrated experience using healthcare data to identify opportunities and drive measurable performance improvement.
• Experience with analytical and reporting tools such as Excel, SQL, Tableau, Power BI, or similar platforms preferred.

Required Skills and Abilities

• Expert knowledge of Risk Adjustment and Burden of Illness principles.
• Strong understanding of compliant clinical documentation and coding practices.
• Strong analytical and data interpretation skills.
• Ability to translate complex performance data into actionable strategies.
• Strong provider engagement and physician relationship skills.
• Ability to lead through influence across clinical and operational teams.
• Strong executive communication and presentation skills.
• Strategic planning and program development capabilities.
• Strong problem-solving and decision-making skills.
• Ability to manage multiple complex initiatives simultaneously.
• Strong leadership and team development capabilities.
• Ability to translate strategic objectives into measurable operational execution.

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Compensation Range:

$144,368.00

to

$216,552.00

The anticipated base salary range represents the Company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.