Medicare Advantage Risk Adjustment Program Lead

CareFirst BlueCross BlueShield; Baltimore (MD); Hybrid; USD 107,000 - 212,000; Full time

Job summary

CareFirst BlueCross BlueShield in the Baltimore area is seeking an experienced professional to drive Medicare Advantage Risk Adjustment performance through oversight of key operational processes, analytics, and strategic initiatives.

The role requires collaboration across departments to improve risk-adjusted revenue and program effectiveness, with a hybrid work arrangement combining home and CareFirst location-based work as needed.

Qualifications

• Bachelor’s degree in Business Management or related field; or 4 additional years of related work experience.
• 8 years of project or program management experience.
• Preferred PMP certification.
• 5+ years in risk adjustment programs and provider incentives; 5+ years in value-based care.

Responsibilities

• Analyzes aggregate Medicare Advantage Risk Adjustment performance across the line of business, leveraging reports and metrics to identify trends and opportunities.
• Monitors and reports on key performance indicators, including risk score performance, coding trends, documentation quality, and revenue impact.
• Partners with stakeholders to investigate performance drivers, validate findings, and support implementation of improvement initiatives.

Skills

Data analysis

Executive presentation

Cross-functional collaboration

Leadership

Process improvement

Communication

Microsoft Office

Education

Bachelor's degree in Business Management or related field

4 years of additional relevant work experience

Master's Degree

PMP Certification

Job description

CareFirst BlueCross BlueShield in the Baltimore area is seeking an experienced professional to drive Medicare Advantage Risk Adjustment performance through oversight of key operational processes, analytics, and strategic initiatives.

The role requires collaboration across departments to improve risk-adjusted revenue and program effectiveness, with a hybrid work arrangement combining home and CareFirst location-based work as needed.