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CareFirst BlueCross BlueShield · 1 week ago

Risk Adjustment Manager- Encounters (Hybrid)

Baltimore, MD

Full-time

Hybrid

Mid, Senior Level

$105K/yr - $195K/yr

5+ years exp

CareFirst BlueCross BlueShield is a healthcare organization focusing on risk adjustment strategies. The Risk Adjustment Manager will oversee the development and execution of corporate risk adjustment strategies, manage performance metrics, and lead a high-performing team to enhance risk awareness and improve business outcomes.

Health CareNon ProfitService Industry

No H1B

Responsibilities

Proactively create, manage and communicate Risk Adjustment related encounter or submission KPIs, OKRs, ROI, action plans, progress and risks within organizational teams

Develop and manage tracking tools, dashboards, and metrics for monitoring the progress of the encounter integrity and submission accuracy in collaboration with cross-functional teams and senior leadership

Conduct impact analysis and formulate actions related to all risk adjustment-related regulatory changes across and implements appropriate changes and processes to impact business outcomes in collaboration with leadership across related teams

Collaborate across the eco-system such as HHS, CMS, States, BCBSA, etc. to drive necessary regulatory improvements

Provide support, education and training to staff to build risk awareness within the organization and achieve departmental goals

Recruit, retain, and develop a high-performing team

Evaluate the performance of each team member, generate development plans and set goals within the context of the corporate policies and procedures

Develop annual goals, and assists with the oversight of departmental budget to control and appropriately allocate resources

Act as a liaison between the business units and the risk adjustment group by promoting a positive environment of collaboration and excellent customer service

Serve as an SME to guide the key stakeholders in bid filings, regulatory filings, and financial performance planning and reporting

Qualification

Risk Adjustment StrategyHealthcare Payor ExperienceRegulatory Guidelines ExpertiseData AnalyticsLeadership SkillsTraining SkillsPerformance MonitoringCollaboration Skills

Required

Bachelor's Degree OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience

5 years experience of progressive responsibility in a healthcare payor environment

1 year experience with supervisory or demonstrated progressive leadership experience within Government Programs and Risk Adjustment functional areas

Knowledge and experience across all regulated markets and mandated risk adjustment submission process & platforms

Expert in regulatory guidelines on Risk Adjustment

Experience successfully planning and monitoring performance to internal stakeholders, and C-suite with a focus on coding data and analytics

Experienced with effective physician/provider collaborative training to support workflow adjustments to improve clinical coding quality

Strong leadership skills, vendor oversight skills and an experience in payer, provider and industry collaboration

Ability to work in a fast-paced environment and drive consistent actions across a matrixed environment