Risk Adjustment Program Manager: Coding & Quality (Hybrid/Remote)

Blue Cross & Blue Shield of Minnesota; Eagan (MN); Híbrido; USD 102 000 - 174 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Medical, dental, and vision insurance

Life insurance

401k

Paid Time Off (PTO)

Volunteer Paid Time Off (VPTO)

Resumo da oferta

Blue Cross and Blue Shield of Minnesota is hiring a Program Manager, Risk Adjustment Coding and Quality to design, implement and manage the Risk Adjustment Coding and Quality Program across Medicare, Medicaid, ACA and Commercial populations.

Lead a certified coding team, ensure accuracy and compliance, and partner with providers, vendors and analytics to improve documentation quality, audit outcomes, and program performance.

Qualificações

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

Responsabilidades

• 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.
• 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.

Conhecimentos

Project management

Team leadership

CMS risk adjustment

HCC coding

RADV audits

Provider education

Lean Six Sigma

PM tools

Microsoft analytics tools

Formação académica

Bachelor’s degree

Masters degree

Ferramentas

PM tools

Microsoft analytics tools

Descrição da oferta de emprego

Blue Cross and Blue Shield of Minnesota is hiring a Program Manager, Risk Adjustment Coding and Quality to design, implement and manage the Risk Adjustment Coding and Quality Program across Medicare, Medicaid, ACA and Commercial populations.

Lead a certified coding team, ensure accuracy and compliance, and partner with providers, vendors and analytics to improve documentation quality, audit outcomes, and program performance.