10 Medicare Advantage risk adjustment experts

Experience: Manager Medicare Risk Adjustment & Coding · CareMore Health

Sr Director Risk Adjustment Government Revenue & Education at UPMC since May 2026. At CareMore Health the roles were Manager Medicare Risk Adjustment & Coding (2021–2023) and Director Risk Adjustment Programs (2023–2025). The profile also lists Supervisor Strategic Risk Adjustment and Quality at Highmark (2016–2021).

Experience: Vice President, Risk Adjustment · Alignment Health

Vice President, Risk Adjustment at Alignment Health since 2022, after serving there as Sr Director, Risk Adjustment Operations (2020–2022). At CareMore Health he was Director, Risk Adjustment & Coding (2014–2018) and Staff Vice President, Medicare Risk Adjustment & Coding (2018–2020); the profile cites 20 years of hands-on experience with the CMS Risk Adjustment/HCC model and extensive RADV and RAPS work.

Experience: Medicare Risk Adjustment Director · Solis Health Plans

Medicare Risk Adjustment Director at Solis Health Plans since 2023; the profile describes Solis as a local Medicare Advantage plan serving Florida residents. Other roles include Director of Risk Adjustment at VivaMas Medical Centers (2023), Risk Adjustment Quality Director at MMM of Florida, Inc. (2021–2023) and InnovaCare Health (2020–2023), and Risk Adjustment Manager at Anthem, Inc. (2016–2020).

Experience: Director of Risk Adjustment · Banner Health Plans

Director of Risk Adjustment at Banner Health Plans since 2025, following Senior Director of Risk Adjustment at Arkos Health (2023–2025) and Risk Adjustment Director at Humana (2016–2023). The profile describes 15 years in risk adjustment and value-based care across Medicare Advantage, Marketplace and Medicaid, leading work to improve documentation accuracy and coding integrity.

Experience: Vice President, Enterprise Risk Adjustment & Data Integrity · EmblemHealth/ConnectiCare

Vice President, Enterprise Risk Adjustment & Data Integrity at EmblemHealth/ConnectiCare since 2019, and listed as Director of Medicare and Commercial Risk Adjustment at ConnectiCare since 2011. At Aetna, a CVS Health Company, he was Head of Medicare Risk Adjustment Revenue Department (2006–2010) and Director of Forecasting & Reporting-Risk Adjustment Revenue (2010–2012); the profile cites direct experience with Medicare and Commercial risk adjustment payment methodologies.

Experience: Director of Risk Adjustment · UCLA Health

Director of Risk Adjustment at UCLA Health since 2022, with a headline describing planning and executing Medicare Advantage risk adjustment strategies. Before that, West Region Risk Adjustment Manager (2020–2021) and Regional Director of Risk Adjustment and Quality Solutions (2021–2022) at Molina Healthcare, and Medicare Risk Adjustment Client Program Outcomes Manager at Optum (2018–2020).

Experience: Medicare Risk Adjustment Lead Director (NY NJ) · Aetna, a CVS Health Company

Medicare Risk Adjustment Lead Director (NY NJ) at Aetna, a CVS Health Company, since 2020. The profile says the role directs the development, management and implementation of Aetna's Medicare risk revenue and coding accuracy strategies for the NY/NJ Medicare market. Before that, Director, DSNP & Medicare Stars Member Navigators at UnitedHealth Group (2015–2019).

Experience: Director, Risk Adjustment · Johns Hopkins Health Plans

Director, Risk Adjustment at Johns Hopkins Health Plans since January 2026, a role the profile ties to optimizing MA risk adjustment revenue. Before that, Director, Risk Adjustment and Revenue Management at Sentara Health Plan (2020–2025) and AVP Finance - Risk Programs at Virginia Premier (2014–2020).

Experience: Director, Medicare Advantage Revenue · Johns Hopkins Health Plans

Former Director, Medicare Advantage Revenue at Johns Hopkins Health Plans (2023–2025), and Director Risk Adjustment at CareFirst BlueCross BlueShield since October 2025, where the profile lists ACA, Medicare and MD Medicaid risk adjustment. At PA Health & Wellness the roles were Manager, Risk Adjustment (2019–2020), Senior Manager, Risk Adjustment (2020–2022) and Director Risk Adjustment (2022–2023).

Experience: Director, Risk Adjustment · Curana Health

Former Director, Risk Adjustment at Curana Health (2022–2023). The profile describes managing Medicare Advantage encounter and supplemental data submissions, error corrections, analytics, chart review programs and CMS RADV audits. Other roles include Director Risk Adjustment Process and Operation at Horizon Blue Cross Blue Shield of New Jersey (2021–2022) and Director Risk Adjustment Analytics at Gateway Health Plan (2020–2021).