Program Manager - Risk Adjustment & HCC

Bluestone delivers great outcomes by bringing exceptional care to patients living with complex, chronic conditions and disabilities. Our unique, robust model of care goes beyond primary care services — our multidisciplinary care teams collaborate with patients, their families and other healthcare providers to deliver care that is preventative, proactive and tailored to their unique needs.

Using an evidence-based approach focused on quality care management and data-driven medical decisions, Bluestone care teams collaborate to manage patients’ chronic conditions, address social determinants of health, manage transitions to and from inpatient settings, provide behavioral health support and more. Under our model of care, Bluestone patients experienced 21% fewer ER visits, 36% fewer hospitalizations and 41% fewer hospital readmissions compared to patients with similar conditions and complexities over the same time period.

Our care teams travel directly to patients who reside in Assisted Living, Memory Care and Group Home communities throughout Minnesota, Wisconsin and Florida and are supported by clinical operations and administrative colleagues who work remotely or at our corporate offices in Stillwater, Minnesota, and Tampa, Florida.

Our success is only possible through the hard work of our employees who bring our core values of Dedication, Excellence, Collaboration and Caring to life every day. Bluestone has been named to the Star Tribune's Top Workplace list for the 14th year in a row! Bluestone also achieved Top Workplace USA 2021-2026! In 2022, Bluestone Accountable Care Organization (ACO) was the best performing ACO in the country as measured by the overall savings per Medicare beneficiary.

Position Overview :

We are seeking a highly motivated and innovative Risk Adjustment & Hierarchical Condition Category (HCC) Program Manager to join our team. In this role, you will have a direct impact on our organization’s success by optimizing our risk adjustment strategies while ensuring that compliant, patient-centered care remains our highest priority. The Risk Adjustment & HCC Program Manager will be a strategic, data-driven leader responsible for overseeing and optimizing Bluestone’s risk adjustment coding operations. This role requires a dynamic individual with a strong desire to succeed, who can seamlessly bridge the gaps between our clinical providers, our EHR functionality, and the Revenue Cycle Management (RCM) organization. You will be tasked with innovating and standardizing our current workflows for risk adjustment, developing standardized querying processes, managing a specialized coding team, and maintaining the highest levels of compliance.

This role reports to the SVP of Clinical Operations.

Schedule: Full time position

Location: This is a hybrid role requiring the flexibility to thrive across remote strategy, field observations, and on-site alignment. Applicants MUST reside within one of Bluestone’s primary markets: Minnesota, Wisconsin, or Florida.

Salary: $120,000 - $138,000 base salary. Salary will be commensurate with experience.

Responsibilities :

• Team Leadership & Management: Directly oversee, mentor, and develop a team of 2 Risk Adjustment Coders. Lead daily operations by managing workload distribution, fostering high team engagement, and driving performance management. Conduct regular 1:1s, provide ongoing training and constructive feedback, and ensure the team maintains high standards of coding accuracy and productivity.
• Standardized Process Development: Design, implement, and manage standardized processes for both proactive (prospective/concurrent) and retrospective risk adjustment queries to ensure accurate capture of patient acuity that are efficient, provider-approved, and compliant.
• Cross-Functional Collaboration: Serve as the primary liaison and foster strong collaboration between the provider network, EHR and clinical teams, and the RCM organization.
• Compliance & Quality Assurance: Ensure all risk adjustment initiatives and coding practices adhere strictly to CMS guidelines, OIG compliance standards, and internal policies. Conduct regular audits and reviews to mitigate risk.
• Provider Education & Engagement: Develop innovative and effective educational materials and feedback loops for providers to improve clinical documentation integrity (CDI) at the point of care.
• Data & Performance Monitoring: Articulate to and collaborate with the analytics team to cultivate the data streams needed to develop KPIs to monitor and objectively evaluate performance, improvement, and areas of opportunity. Track and report on team productivity, HCC capture rates, query response rates, and overall program success.
• Program Innovation: Continuously evaluate current risk adjustment programs to identify opportunities for innovation, efficiency, and revenue integrity, always ensuring that process changes support high-quality patient care delivery.

Qualifications :

Education/Certification/Experience

• Experience: Minimum of 5 years of experience in the healthcare industry with a dedicated focus on risk adjustment coding optimization and HCC program management, including previous supervisory or team lead experience.
• Required Certifications: CRC (Certified Risk Adjustment Coder) through AAPC is strongly preferred. Note: If you do not currently hold a CRC, you must have a willingness to obtain it within an agreed-upon timeframe after hire.
• Preferred Additional Certifications: Active CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) credential.
• Knowledge: Deep understanding of CMS-HCC risk adjustment models, ICD-10-CM coding guidelines, and regulatory compliance requirements.

Knowledge/Skills/Abilities

• Innovation & Strategy: A forward-thinking mindset with a proven track record of innovating processes and overcoming operational challenges.
• Collaboration & Leadership: Exceptional interpersonal and communication skills, with the ability to build trust, inspire a team, and work effectively across diverse departments (Clinical, RCM, Operations).
• Drive for Success: A highly motivated self-starter with a strong desire to succeed and achieve programmatic excellence.
• Patient-Centric Focus: An unwavering commitment to keeping quality and efficient patient care delivery at the heart of all business and operational decisions.
• Influence With & Without Authority: Exceptional interpersonal and communication skills with a proven ability to align diverse teams (providers, operational staff, IT, leadership) around shared goals with and without direct line authority.
• Matrixed Accountability: Comfort operating and accepting accountability within a highly collaborative, matrixed organizational structure.
• Analytical Mindset: Ability to convert complex health data and quality metrics into actionable operational strategies.
• Adaptability: Flexibility to thrive in a hybrid work environment (combining remote strategy, field observations, and on-site alignment).
• Change Management/Process Improvement: Ability to help drive change effectively and collaboratively, with an eye for processes requiring improvement and efficiency.
• Data and Informatics Fluency: Ability to understand how to develop data streams in concert with the EHR and systems available that support or drive the workflows necessary to drive outcomes

Bluestone Benefits :

• Health Insurance
• Dental Insurance
• Vision Materials Insurance
• Company paid Life Insurance
• Company paid Short and Long-term Disability
• Health Savings Account (with employer contribution)
• Flexible Spending Account (FSA)
• Retirement plan with 4% matching contributions
• Ten (10) Paid Holidays
• Three weeks (15 Days) Paid Time Off (PTO)
• Company sponsored cell phone and computer accessories

Pay Transparency

$120,000—$138,000 USD