Program Manager, Risk Adjustment Coding and Quality

About Blue Cross and Blue Shield of Minnesota

At Blue Cross and Blue Shield of Minnesota we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate you are joining a culture that is built on values of succeeding together finding a better way and doing the right thing. If you are ready to make a difference join us.

The Impact Youll Have

Blue Cross and Blue Shield of Minnesota is hiring a Program Manager Risk Adjustment Coding and this position youll be responsible for the design implementation evaluation and ongoing management of the Risk Adjustment Coding and Quality Program supporting Medicare Medicaid ACA and Commercial populations to optimize Blue Crosss earned risk-adjusted revenue. The role serves as the subject matter expert for risk adjustment coding partnering with leadership and cross-functional teams to develop and execute strategic initiatives identify data trends and implement performance improvement opportunities through collaboration with analytics and other key stakeholders. The incumbent ensures program strategies and operations meet evolving regulatory market provider and member requirements while addressing complex business challenges and supporting organizational change. Acting as a liaison across multiple departments the individual leads enterprise-wide initiatives drives results within established timelines and provides leadership and oversight to program management staff within the division.

Working closely with the Director this position supports the implementation of strategic initiatives monitors project progress and oversees team and vendor performance to ensure key objectives and deadlines are achieved. The role leads coding and audits review activities including medical record reviews to support accurate risk adjustment revenue compliance audits of provider and vendor documentation to ensure accuracy and completeness and operational readiness efforts for government audits related to risk adjustment programs.

What Youll Do

• Lead Medicare Advantage (MA) and ACA Risk Adjustment coding operations including chart review programs RADV and HRADV audit readiness and coding validation activities to ensure accurate risk score capture regulatory compliance and revenue optimization. Expert in HCC and HHS risk adjustment methodology.
• Manage and develop a team of certified coding professionals (CPCs) providing leadership oversight and coaching while driving coding accuracy quality performance and operational excellence.
• Partner with providers vendors and cross-functional stakeholders to deliver risk adjustment education ensure vendor performance and compliance and implement strategies that improve documentation quality and audit outcomes.

How Youll Do It

• Drive the development and documentation of design requirements and implementation required to support initiatives that align with strategic priorities.
• Develop relationships and partner with key resources both internal and external to collaborate on the design and ensure all market member and provider considerations are factored into the design.
• Drive business decision making process to ensure capabilities systems and processes meet market expectations and that alternate approaches are vetted and explored.
• Manage related ongoing program management work to understand what is needed to recommend strategy and solutions while influencing and steering others to accomplish that strategy across multiple complex programs.
• Ensure that appropriate metrics are chosen and that the appropriate measurement data analysis and evaluation occur for each initiative.
• Develop and continually update program or project plans timelines and deliverables while coordinating multiple sub-processes to expand and/or improve complex programs.
• Develop and implement a communication plan in conjunction with leadership and to support initiatives including status and progress updates.
• Stay abreast of changes in the rapidly evolving health care marketplace and in regulatory or qualitymeasurement programs .
• Performs additional responsibilities consistent with the scope and level of the role as assigned.

Required Skills & Experience

• 5 years of progressive project/program management experience with 1 staff team lead or project lead experience.
• Bachelors degree; in lieu of a degree an additional two years of relevant experience beyond the qualifications listed above may be accepted.

Preferred Skills & Experience

• Strong knowledge of CMS risk adjustment models (ACA and Medicare Advantage).
• Experience with HCC coding RADV audits and/or chart review programs preferred.
• CPC CCS or CRC coding certification strongly preferred.
• Experience developing or supporting provider education or training initiatives preferred.
• Masters degree in related field.
• Ability to communicate expectations and priorities clearly to team members actively listen to resolve issues and remove barriers and drive alignment across teams and stakeholders.
• Ability to analyze department challenges guide team decision-making and collaborate across teams to drive resolution and next steps.
• Ability to effectively organize team work balance priorities across projects and manage time and resources to ensure timely delivery and coordination.
• Healthcare or managed care experience.
• Experience managing complex projects which may involve multiple team members task assignment working with internal or external clients managing teams and customer relationships and managing project deliverables.
• Experience in data-driven decision-making.
• Process improvement (Lean / Six Sigma) experience.
• Familiarity with PM tools & Microsoft analytics tools.

Role Designation

Hybrid

Role designation definition:

• Teleworking is working full time remote.
• Hybrid is a minimum of 2 days onsite.
• Onsite is full-time onsite.

Anchored in Connection

Our hybrid approach is designed to balance flexibility with meaningful in-person connection and collaboration. We come together in the office two days each week most teams designate at least one anchor day to ensure team interaction. These in-person moments foster relationships creativity and alignment. The rest of the week you are empowered to work remote.

Compensation and Benefits

$102400.00 - $138300.00 - $174200.00 Annual

Pay is based on several factors which vary based on position including skills ability and knowledge the selected individual is bringing to the specific job.

We offer a comprehensive benefits package which may include:

• Medical dental and vision insurance

• Life insurance

• 401k

• Paid Time Off (PTO)

• Volunteer Paid Time Off (VPTO)

• And more

To discover more about what we have to offer please review our benefits page .

Equal Employment Opportunity Statement

At Blue Cross and Blue Shield of Minnesota we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to and will not be discriminated against based on any legally protected characteristic.

Individuals with a disability who need a reasonable accommodation in order to apply please contact us at:

Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association.

Required Experience:

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