Head of Business Risk

Risk Adjustment Manager of Government Submissions

Eagan, MN or 100% remote Duration: FTE

The Manager of Government Submissions leads a high performing team responsible for government submissions across Client MN's government programs - Medicare, Medicaid, and Affordable Care Act (ACA). This position is responsible for supporting all data-driven initiatives concerning government submissions including our risk adjustment and quality programs while leading, mentoring, and motivating a diverse team of business and data analysts. This role requires coordination with multiple stakeholders to implement and execute the accurate, complete, and truthful submission of data to multiple entities including vendors performing activities or analyses on our behalf, third-party data collection and submissions entities, and government bodies such as CMS, HHS, and Client. This individual will have significant Medicare experience as a core requirement, with broader experience across Medicaid and ACA preferred, and a solid understanding of healthcare data. This role requires hands-on experience with SQL, Power BI, and encounter data submissions. Strong leadership, problem-solving, communication, and collaboration skills are essential to support teams and ensure compliance in a fast-paced, regulated environment.

Develop, lead, and provide strategic direction for a high performing team responsible for the execution and day-to-day management of data submissions for ACA Commercial, Medicare, and Medicaid risk adjustment and quality programs.

Oversee the development, implementation, and automation of business and reporting strategies concerning government submissions by partnering with key stakeholders to ensure their design, planning, and implementation needs are being met while ensuring alignment with strategic business objectives.

Direct research, analysis, and interpretation of risk adjustment and quality data and provide technical assistance to other departments including Underwriting, Government Programs, Finance, Network Management, Health Management, Sales and Marketing, Legal, and Senior Staff.

Review and maintain processes to assess and prevent data loss that may impact risk adjustment accuracy or quality programs.

Engage, participate, and present in risk adjustment and quality strategic planning activities by partnering with internal stakeholders to develop strategies, goals, objectives and initiatives that align to corporate and divisional priorities.

Manage the department, interviewing and hiring employees following required EEO and Affirmative Action guidelines, and ensure employees receive the proper training.

Conduct performance evaluation, and is responsible for managing employees, including skill and career development, policy administration, discipline, employee relations and cost control.

5 years of related professional experience, with 3 years of management experience. Excellent knowledge of Medicare Advantage and/or the ACA marketplace and understanding of CMS initiatives and reasoning.

• Expert level knowledge of SQL Server, SSIS, SSRS.
• Expert level knowledge of MS Access, Excel, PowerPoint, and MS Word.
• Strong knowledge of data visualization software.
• Exceptional creative thinking, problem-solving, and critical thinking skills.
• Strong data analysis skills including ability to analyze and interpret data using SQL or comparable data tools and develop strategic recommendations.
• Demonstrated delegation and management skills.
• High school diploma (or equivalency) and legal authorization to work in the U.Bachelor's degree in Finance, Mathematics, Computer Science, Health Science or Data Science.

Experience leading Risk Adjustment submission teams in Health insurance companies, Healthcare providers, Healthcare technology add regulators (CMS, department of health, etc.) Experience leading HEDIS data collection and submissions.

Knowledge of statistical software (R or SAS).