Risk Adjustment Coding & Quality Program Lead

BCBSM, Inc.; Eagan (MN); Hybrid; USD 102,000 - 174,000; Full time

Benefits offered by this job

Medical, dental, and vision insurance

Life insurance

401k

Paid Time Off

Volunteer Paid Time Off

And more

Job summary

Blue Cross and Blue Shield of Minnesota is seeking a Program Manager, Risk Adjustment Coding and Quality to lead Medicare Advantage and ACA risk adjustment coding operations, ensuring accurate risk scores and revenue optimization across regulatory requirements.

You will supervise certified coding professionals, partner with providers and vendors, and drive data-driven improvements in documentation quality and audit readiness within a hybrid work model in Minnesota.

Qualifications

• 5+ years of progressive project/program management experience, including staff and leadership responsibilities.
• Bachelor’s degree required; additional two years of relevant experience may substitute for a degree.

Responsibilities

• Lead MA and ACA Risk Adjustment coding operations, including chart review programs and audit readiness.
• Manage and develop a team of CPCs, driving accuracy, quality, and performance.
• Collaborate with providers, vendors, and cross-functional teams to improve documentation and audit outcomes.

Skills

Project management

Team leadership

CMS risk adjustment knowledge

HCC risk adjustment

Data-driven decision making

Education

Bachelor’s degree

Master’s degree

Tools

PM tools

Microsoft analytics tools

Job description

Blue Cross and Blue Shield of Minnesota is seeking a Program Manager, Risk Adjustment Coding and Quality to lead Medicare Advantage and ACA risk adjustment coding operations, ensuring accurate risk scores and revenue optimization across regulatory requirements.

You will supervise certified coding professionals, partner with providers and vendors, and drive data-driven improvements in documentation quality and audit readiness within a hybrid work model in Minnesota.